Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
CJEM. 2024 Aug;26(8):535-542. doi: 10.1007/s43678-024-00740-1. Epub 2024 Aug 2.
For emergency department (ED) patients with syncope, cardiac troponin can identify acute coronary syndrome (ACS) and prognosticate for 30-day serious adverse events. However, it is unclear if serial testing improves diagnostic yield and prognostication.
This was a secondary analysis of data from two prospective studies conducted to develop the Canadian Syncope Risk Score. Adults (age ≥ 16 years) with syncope were enrolled, and patient characteristics, vital signs, physician diagnostic impression, electrocardiogram and troponin results, and adjudicated 30-day serious adverse event were collected. The primary outcome was the detection of a serious adverse event within 30 days of ED disposition. The secondary outcome was comparison of ED length of stay among patients with single versus serial troponin measurements.
4996 patients [mean age 64.5 (SD 18.8) years, 52.2% male] were included: 4397 (89.8%) with single troponin [232 (5.3%) with serious adverse event in the ED and 203 (4.6%) after ED disposition]; 499 (10.2%) patients with > 1 troponin measurement [39 (7.8%) with serious adverse event in ED and 60 (12.0%) after ED disposition]. Among those with serial measurements, 10 patients (2.0%) had a rise from below to above the 99th percentile threshold, of whom 4 patients (0.8%) suffered serious adverse event: two with arrhythmias diagnosed on electrocardiogram, one with ACS and one suffered respiratory failure. Nine patients (1.8%) had Canadian Syncope Risk Score risk reclassification based on serial measurement, and none suffered 30-day serious adverse event. Median ED length of stay was significantly longer for patients with serial testing (5.6 vs. 3.8 h, p < 0.001).
The initial troponin measurement was sufficient for serious adverse event detection and in-ED risk stratification. Serial troponin testing does not improve the diagnostic yield or prognostication and should be reserved for patients with ongoing symptoms or electrocardiogram findings suggestive of cardiac ischemia.
对于急诊科（ED）出现晕厥的患者，心脏肌钙蛋白可用于识别急性冠脉综合征（ACS）并预测 30 天内的严重不良事件。然而，连续检测是否能提高诊断率和预后尚不清楚。
这是对两项前瞻性研究数据的二次分析，这些研究旨在开发加拿大晕厥风险评分。纳入年龄≥16 岁、有晕厥的成年人，收集患者特征、生命体征、医生诊断印象、心电图和肌钙蛋白结果以及经裁决的 30 天内严重不良事件。主要结局为 ED 处置后 30 天内发生严重不良事件。次要结局为比较单次与连续肌钙蛋白测量的 ED 住院时间。
共纳入 4996 例患者[平均年龄 64.5（18.8）岁，52.2%为男性]：4397 例（89.8%）接受单次肌钙蛋白检测[ED 中有 232 例（5.3%）发生严重不良事件，ED 处置后有 203 例（4.6%）]；499 例（10.2%）患者进行了>1 次肌钙蛋白测量[ED 中有 39 例（7.8%）发生严重不良事件，ED 处置后有 60 例（12.0%）]。在接受连续测量的患者中，有 10 例（2.0%）从低于第 99 百分位阈值上升至高于第 99 百分位阈值，其中 4 例（0.8%）发生严重不良事件：2 例心电图诊断为心律失常，1 例 ACS，1 例呼吸衰竭。9 例（1.8%）患者根据连续测量重新分类为加拿大晕厥风险评分高危，无患者发生 30 天内严重不良事件。连续检测患者的 ED 中位住院时间明显延长（5.6 小时比 3.8 小时，p<0.001）。
初始肌钙蛋白测量足以检测严重不良事件和 ED 内风险分层。连续肌钙蛋白检测不能提高诊断率和预后，应保留给有持续症状或心电图检查提示心肌缺血的患者。
