Syryca Finn, Haller Bernhard, Schmid Lisa, Kallweit Christiane, Nicol Philipp, Trenkwalder Teresa, Kanz Karl-Georg, Haas Anja, Dommasch Michael
Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany.
Institute for AI and Informatics in Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Int J Emerg Med. 2024 Oct 7;17(1):141. doi: 10.1186/s12245-024-00735-w.
High-sensitive cardiac troponin T (hs-cTnT) assessments are routinely conducted in German emergency departments (EDs). However, data describing a large number of ED patients with pathological hs-cTnT levels and subsequent clinical outcomes are limited.
This retrospective descriptive analysis included 141.892 patients who presented to the interdisciplinary ED at Klinikum rechts der Isar in Munich, Germany, between January 2019 and December 2021. Patients with trauma diagnoses were excluded, focusing on those with elevated hs-cTnT levels. These patients were categorized into three groups based on the International Classification of Procedures in Medicine (ICPM): those with elevated hs-cTnT who received no coronary angiography (NCA), those who underwent diagnostic coronary angiography (DCA), and those who received percutaneous coronary intervention (PCI). The objective of this study was to characterize a large emergency department patient cohort and assess their subsequent clinical outcomes.
After initial Manchester Triage Sytem (MTS) categorization, 32.6% (46.307/141.892) of patients were identified as non-trauma cases. Of these, 9.9% (4.587/46.307) had hs-cTnT levels exceeding 14 ng/L. Within this subset, 70.4% (3.230/4.587) did not undergo coronary angiography, 15.4% (705/4.587) underwent DCA and 14.2% (652/4.587) received PCI. Chest pain occurred more frequently in the PCI group (28.0%, 160/652) compared to the DCA group (18.3%, 113/705) or NCA group (5.7%, 159/3230), p < 0.001. However, breathing problems occurred more frequently in the NCA group (23.2%, 647/3230) compared to the PCI group (17.7%, 101/652) or DCA group (21.8%, 135/705), p < 0.001. Also, collapse was more frequent in patients in the NCA group (4.0%, 112/3230) compared to the DCA group (3.4%, 21/705) or PCI group (3.5%, 20/652), p < 0.001. Overall, in-hospital mortality was significantly higher in the NCA group (7.9%, 256/3230) compared to the DCA group (2.3%, 16/705) or PCI group (4.1%, 27/652), p < 0.001.
Emergency patients with elevated hs-cTnT who did not undergo coronary angiography faced a higher risk of in-hospital mortality in our retrospective descriptive study. Given the heterogeneous nature of presenting complaints in emergency departments, identifying at-risk patients can pose challenges for treating physicians.
德国急诊科常规进行高敏心肌肌钙蛋白T（hs-cTnT）检测。然而，关于大量hs-cTnT水平异常的急诊科患者及其后续临床结局的数据有限。
这项回顾性描述性分析纳入了2019年1月至2021年12月期间在德国慕尼黑伊萨尔河右岸医院跨学科急诊科就诊的141892例患者。排除有创伤诊断的患者，重点关注hs-cTnT水平升高的患者。根据国际医学操作分类（ICPM），将这些患者分为三组：hs-cTnT升高但未接受冠状动脉造影（NCA）的患者、接受诊断性冠状动脉造影（DCA）的患者以及接受经皮冠状动脉介入治疗（PCI）的患者。本研究的目的是描述一个大型急诊科患者队列的特征并评估其后续临床结局。
经过最初的曼彻斯特分诊系统（MTS）分类，32.6%（46307/141892）的患者被确定为非创伤病例。其中，9.9%（4587/46307）的患者hs-cTnT水平超过14 ng/L。在这个亚组中，70.4%（3230/4587）未接受冠状动脉造影，15.4%（705/4587）接受了DCA，14.2%（652/4587）接受了PCI。与DCA组（18.3%，113/705）或NCA组（5.7%，159/3230）相比，PCI组胸痛发生率更高（28.0%，160/652），p<0.001。然而，与PCI组（17.7%，101/652）或DCA组（21.8%，135/705）相比，NCA组呼吸问题发生率更高（23.2%，647/3230），p<0.001。此外，与DCA组（3.4%，21/705）或PCI组（3.5%，20/652）相比，NCA组患者虚脱发生率更高（4.0%，112/3230），p<0.001。总体而言，与DCA组（2.3%，16/705）或PCI组（4.1%，27/652）相比，NCA组住院死亡率显著更高（7.9%，256/3230），p<0.001。
在我们的回顾性描述性研究中，hs-cTnT升高但未接受冠状动脉造影的急诊患者住院死亡风险更高。鉴于急诊科就诊主诉的异质性，识别高危患者对治疗医生来说可能具有挑战性。
