Roos Andreas, Edgren Gustaf
Department of Emergency and Reparative Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solna, Stockholm, Sweden.
Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Cardiology, Södersjukhuset, Stockholm, Sweden.
Am J Med. 2024 Jul;137(7):597-607.e5. doi: 10.1016/j.amjmed.2024.03.005. Epub 2024 Mar 13.
Knowledge is limited on the clinical implications of high-sensitivity cardiac troponin (hs-cTn) measurements in patients treated with oral antineoplastic agents associated with cardiovascular side effects. This study investigated the diagnostic performance of hs-cTnT for myocardial infarction.
Among all visits to 7 different emergency departments (EDs) from December 9, 2010 to August 31, 2017, we included visits by patients presenting with chest pain who had ≥1 hs-cTnT measured. Patients treated with oral antineoplastic agents associated with cardiovascular toxicity were identified. Logistic regression models were used to estimate the performance of hs-cTnT for diagnosing myocardial infarction.
We identified 214,165 visits, of which 2695 (1.3%) occurred in patients with oral antineoplastic treatment associated with cardiovascular toxicity. Treatment was associated with a higher myocardial infarction incidence (8.2% vs 5.7%), but the overall diagnostic accuracy for a myocardial infarction was lower in patients with versus without treatment, paralleled by a lower specificity and PPV with the 0 h hs-cTnT rule-in cut-off of 52 ng/L (92.6% [95% CI: 91.6-93.6] vs 96.8% [95% CI: 96.8-96.9], and 42.8 [95% CI: 37.4-48.2] vs 49.5 [95% CI: 48.6-50.4], respectively). The majority (72%) of patients with treatment were assigned to an intermediate risk group, in whom the risk of myocardial infarction was reduced by 29% (OR 0.71, 95% CI: 0.57-0.89).
Diagnostic accuracy of hs-cTnT for myocardial infarction is reduced among patients on treatment with oral antineoplastic agents associated with cardiovascular toxicity. Most patients would be assigned to an intermediate risk group, in whom only 4% will have a final myocardial infarction diagnosis.
对于接受具有心血管副作用的口服抗肿瘤药物治疗的患者，高敏心肌肌钙蛋白（hs-cTn）检测的临床意义的认识有限。本研究调查了hs-cTnT对心肌梗死的诊断性能。
在2010年12月9日至2017年8月31日期间对7个不同急诊科（ED）的所有就诊患者中，我们纳入了出现胸痛且至少检测过1次hs-cTnT的患者。确定接受具有心血管毒性的口服抗肿瘤药物治疗的患者。使用逻辑回归模型来评估hs-cTnT诊断心肌梗死的性能。
我们确定了214,165次就诊，其中2695次（1.3%）发生在接受具有心血管毒性的口服抗肿瘤治疗的患者中。治疗与较高的心肌梗死发生率相关（8.2%对5.7%），但治疗组患者心肌梗死的总体诊断准确性低于未治疗组，同时在hs-cTnT 0小时诊断界值为52 ng/L时特异性和阳性预测值较低（分别为92.6% [95% CI：91.6 - 93.6]对96.8% [95% CI：96.8 - 96.9]，以及42.8 [95% CI：37.4 - 48.2]对49.5 [95% CI：48.6 - 50.4]）。大多数（72%）接受治疗的患者被归为中度风险组，其中心肌梗死风险降低了29%（OR 0.71，95% CI：0.57 - 0.89）。
在接受具有心血管毒性的口服抗肿瘤药物治疗的患者中，hs-cTnT对心肌梗死的诊断准确性降低。大多数患者将被归为中度风险组，其中只有4%最终会被诊断为心肌梗死。
