De Jongh Frank W, Pouwels Sjaak, De Jongh Marjolein C, Dubois Eric A, van Schaik Ron H N
Department of Clinical Chemistry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
J Clin Med. 2022 Dec 1;11(23):7147. doi: 10.3390/jcm11237147.
Background: high sensitive Troponin T (hsTnT) values between 14−50 ng/L represent a challenge in diagnosing acute coronary syndrome (ACS) at the Emergency Department (ED). The European Society for Cardiology (ESC) recommends a second hsTnT measurement 3 h later to distinguish between ACS and other causes depending on the Δ hsTnT. Our study aims to evaluate the predictive power this approach in a clinical setting by following patients presenting at the ED with hsTnT values 14−51 ng/L. Materials and methods: patients presenting with chest pain or dyspnea and a hsTnT value between 14 and 50 ng/L at the Erasmus MC ED in 2012−2013 were included and retrospectively monitored for 90 days after initial presentation for the occurrence of a cardiac revascularization. Patient records were reviewed according to the standing protocol, which depended on the Δ hsTnT. The “event-group” consists of patients receiving cardiac revascularization within 90 days after the ED visit, whereas the “no event-group” consisted of patients without revascularization. Results: a total of 889 patients patient records were reviewed. After excluding out-of-hospital-cardia-arrests (60), non-cardiological chest pain (373) and incomplete follow-up (100), 356 patients remained for final analysis. In 207 patients, a second hsTnT was actually performed (58%). From these 207 patients, 68 (33%) had a Δ hsTnT ≥7 ng/L. In these patients, 37 (54%) experienced an event within 90 days. In the 139 patients with a Δ hsTnT < 7 ng/L, 23 (17%) presented with an event within 90 days. Conclusion: our study demonstrated a sensitivity of 62%, a specificity of 79%, a positive predicted value (PPV) of 54% and a negative predictive value (NPV) of 83% for using a 3-h Δ hsTnT ≥7 ng/L cut-off, related to risk of an event in 90 days following ED presentation.
14 - 50 ng/L之间的高敏肌钙蛋白T（hsTnT）值给急诊科（ED）诊断急性冠状动脉综合征（ACS）带来了挑战。欧洲心脏病学会（ESC）建议3小时后进行第二次hsTnT测量，以根据hsTnT的变化（ΔhsTnT）区分ACS和其他病因。我们的研究旨在通过对ED中hsTnT值为14 - 51 ng/L的患者进行随访，评估这种方法在临床环境中的预测能力。材料和方法：纳入2012 - 2013年在伊拉斯谟医学中心急诊科因胸痛或呼吸困难且hsTnT值在14至50 ng/L之间就诊的患者，并在首次就诊后进行90天的回顾性监测，观察是否发生心脏血运重建。根据既定方案审查患者记录，该方案取决于ΔhsTnT。“事件组”包括在ED就诊后90天内接受心脏血运重建的患者，而“无事件组”包括未进行血运重建的患者。结果：共审查了889例患者记录。排除院外心脏骤停患者（60例）、非心脏性胸痛患者（373例）和随访不完整患者（100例）后，剩余356例患者进行最终分析。在207例患者中，实际进行了第二次hsTnT检测（58%）。在这207例患者中，68例（33%）的ΔhsTnT≥7 ng/L。在这些患者中，37例（54%）在90天内发生了事件。在139例ΔhsTnT < 7 ng/L的患者中，23例（17%）在90天内出现了事件。结论：我们的研究表明，使用3小时ΔhsTnT≥7 ng/L的截断值，其敏感性为62%，特异性为79%，阳性预测值（PPV）为54%，阴性预测值（NPV）为83%，这与ED就诊后90天内发生事件的风险相关。
