Department of Emergency and Reparative Medicine, Karolinska University Hospital, Huddinge Stockholm, Sweden
Department of Medicine Clinical Epidemiology Division, Karolinska Institutet, Solna Stockholm, Sweden.
Heart. 2022 Dec 22;109(2):127-133. doi: 10.1136/heartjnl-2022-321198.
Many patients who present with chest pain have previous measurements of high-sensitivity cardiac troponin T (hs-cTnT). The clinical usefulness of incorporating these measurements in identifying patients who are at a high risk of myocardial infarction (MI) is unknown. We investigated if the relative change between a historical hs-cTnT and the admission hs-cTnT could improve early identification of patients with a high risk of MI.
We included all patients presenting with chest pain to seven different emergency departments (EDs) in Sweden from December 2009 to December 2016, who had at least one hs-cTnT measurement at the presentation and at least one available prior measurement. We used logistic regression to investigate the diagnostic performance of using various combinations of current and historical hs-cTnT measurements in diagnosing MI within 30 days.
A total of 27 809 visits were included, among whom 2686 (9.7%) had an MI within 30 days. A cut-off value for historical hs-cTnT-adjusted admission hs-cTnT with similar specificity (91.2%) as an admission hs-cTnT of ≥52 ng/L identified 4% more MIs (43% vs 39%) and had a higher positive predictive value, 42.6% (95% CI, 41.0% to 44.3%) vs 38.9% (95% CI 37.4% to 40.4%), as well as a higher positive likelihood ratio, 6.95 (95% CI 6.69 to 7.22) vs 5.95 (95% CI 5.73 to 6.18). Among patients with an admission hs-cTnT of <52 ng/L who were classified as high-risk patients when incorporating past hs-cTnT measurements, 28% suffered an MI.
Historical hs-cTnT levels can be used with admission hs-cTnT to improve early risk stratification of MI in the ED.
许多胸痛患者有之前高敏肌钙蛋白 T（hs-cTnT）的测量值。将这些测量值纳入识别心肌梗死（MI）高危患者的临床应用价值尚不清楚。我们研究了历史 hs-cTnT 与入院 hs-cTnT 之间的相对变化是否可以提高 MI 高危患者的早期识别率。
我们纳入了 2009 年 12 月至 2016 年 12 月期间瑞典 7 家不同急诊科就诊的所有胸痛患者，这些患者在就诊时至少有一次 hs-cTnT 测量值，且至少有一次可获取的既往测量值。我们使用逻辑回归分析来研究当前和既往 hs-cTnT 测量值的各种组合在 30 天内诊断 MI 的诊断性能。
共纳入 27809 例就诊，其中 2686 例（9.7%）在 30 天内发生 MI。与入院 hs-cTnT≥52ng/L 具有相似特异性（91.2%）的历史 hs-cTnT 校正入院 hs-cTnT 的截断值可识别出更多的 MI（4%，43% vs 39%），且阳性预测值更高，为 42.6%（95%CI，41.0%至 44.3%），阳性似然比更高，为 6.95（95%CI，6.69 至 7.22），而入院 hs-cTnT<52ng/L 的患者中，纳入既往 hs-cTnT 测量值后被归类为高危患者的患者中，有 28%发生了 MI。
历史 hs-cTnT 水平可与入院 hs-cTnT 联合使用，以改善急诊科 MI 的早期危险分层。
