Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia.
South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
Emerg Med Australas. 2024 Feb;36(1):62-70. doi: 10.1111/1742-6723.14298. Epub 2023 Sep 13.
To examine management and outcomes of patients presenting to EDs with symptoms suggestive of acute coronary syndrome, who have mild non-dynamically elevated high-sensitivity troponin T (HsTnT) levels, not meeting the fourth universal definition of myocardial infarction (MI) criteria (observation group).
Consecutive patients presenting to the ED with symptoms suggestive of acute coronary syndrome at Liverpool Hospital, Sydney, Australia, those having ≥2 HsTnT levels after initial assessment were adjudicated according to the fourth universal definition of MI, as MI ruled-in, MI ruled-out, or myocardial injury in whom MI is neither ruled-in nor ruled-out (>1 level ≥15 ng/L, called observation group); follow-up was 5 years.
Of 2738 patients, 547 were in the observation group, of whom 62% were admitted to hospital, 52% to cardiac services, whereas 97% of MI ruled-in patients and 21% of MI ruled-out patients were admitted; P < 0.001. Non-invasive testing occurred in 42% of observation group patients (36% had echo-cardiography), and 16% had coronary angiography. Of observation group patients, MI rates were 1.5% during hospitalisation and 4% during the following year, similar to that in those with MI ruled-in, among those with MI ruled-out, the MI rate was 0.2%. The 1-year death rate was 13% among observation group patients and 11% MI ruled-in patients (P = 0.624), whereas at 5 years among observation group patients, type 1 MI and type 2 MI were 48%, 26% and 58%, respectively (P = 0.001).
Very few unselected consecutive patients attending ED, with minor stable HsTnT elevation, had MI, although most had chronic myocardial injury. Late mortality rates among observation group patients were higher than those with confirmed type 1 MI but lower than those with type 2 MI.
探讨就诊于急诊科（ED）并出现疑似急性冠状动脉综合征症状、高敏肌钙蛋白 T（hsTnT）水平轻度非动态升高且不符合心肌梗死（MI）第四通用定义标准的患者（观察组）的管理和结局。
在澳大利亚悉尼利物浦医院，连续纳入出现疑似急性冠状动脉综合征症状并就诊于 ED 的患者，对初始评估后至少有 2 次 hsTnT 水平升高的患者，根据 MI 第四通用定义进行裁决，即 MI 确诊、MI 排除或心肌损伤（MI 既未确诊也未排除，至少有 1 次 hsTnT 水平升高≥15ng/L，归入观察组）；随访 5 年。
在 2738 例患者中，547 例归入观察组，其中 62%入院，52%入心脏科病房，而 MI 确诊患者中 97%和 MI 排除患者中 21%入院；P＜0.001。观察组患者中 42%进行了非侵入性检查（36%行超声心动图检查），16%进行了冠状动脉造影检查。观察组患者中，住院期间 MI 发生率为 1.5%，第 1 年 MI 发生率为 4%，与 MI 确诊患者相似，MI 排除患者中 MI 发生率为 0.2%。观察组患者第 1 年的死亡率为 13%，MI 确诊患者为 11%（P=0.624），而观察组患者在第 5 年，1 型 MI 和 2 型 MI 分别为 48%、26%和 58%（P=0.001）。
就诊于 ED 且 hsTnT 轻度稳定升高的未选择连续患者中，极少数患者发生 MI，但多数患者存在慢性心肌损伤。观察组患者的晚期死亡率高于确诊 1 型 MI 患者，但低于 2 型 MI 患者。
