Camp Samantha, Elhamdani Ameen, Zinabu Samrawit, McGinnis Patrick, Mearns-Escobar Nateniel, Michael Miriam, Pourmand Ali, Brent Becker A, Myers Bennett A, Tran Quincy K
University of Maryland School of Medicine, MD, USA.
Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, MD, USA.
Am J Emerg Med. 2025 Sep;95:7-15. doi: 10.1016/j.ajem.2025.04.067. Epub 2025 May 1.
Emergency department (ED) patients presenting with supraventricular tachycardia (SVT) often undergo laboratory testing, including troponin levels, despite previous literature suggesting an overall low prevalence of major adverse cardiac events (MACE) in this population. Better understanding of the prognostic utility of troponin in patients with SVT may help optimize disposition of these patients. We aimed to compare rates of 30-day MACE among SVT patients with serum troponin testing (YesTrop) versus those without (NoTrop).
This retrospective, propensity-score-matched cohort study was completed using the TriNetX database. TriNetX includes data from 93 different large healthcare organizations (HCOs) with over 132 million patient records, including over 500,000 patients with a diagnosis of SVT presenting to an ED. Patients were included if they presented to ED with first-time SVT, with or without troponin testing. Patients were excluded if they had previous MACE history. Propensity-score matching was performed according to past medical history, triage vital signs, and laboratory markers. Statistical analyses, including risk analysis and outcome frequency, were conducted using TriNetX analytical tools.
The TriNetX database yielded a total of 225,778 patients meeting inclusion criteria with 31,291 included in each group after propensity score matching. Mean age (+/- Standard Deviation [SD] was 58 +/- 18 years), 17,043 (54.5 %) were female and a majority were white (69.8 %). Individual components of MACE with the greatest risk difference were acute myocardial infarct with a risk difference of -3.3 % (95 % CI -0.356 to -0.299, p < 0.001) and heart failure with a risk difference of -3.8 % (95 % CI -0.414 to -0.336, p < 0.001). Total MACE for the NoTrop group was 10.5 % (3816 events) vs 21.6 % (7826 events) in the YesTrop group (Risk difference 11.1 %, 95 % CI -0.11 to -0.116, P < 0.001). Higher percentage of YesTrop group had hospital diagnoses of hypertension, diabetes, and chronic respiratory diseases, including COPD, emphysema, and bronchitis.
In this study involving a large number of patients with SVT, patients who had serum troponin evaluation were associated with higher-risk of 30-day MACE events. However, patients who had troponin evaluation also had higher rates of comorbidity that might have prompted clinicians to check troponin. Until further studies are available, clinicians should exercise their clinical judgement in weighing the risks and benefits of ordering troponin on patients presenting with SVT.
尽管既往文献表明，急诊科（ED）中表现为室上性心动过速（SVT）的患者发生主要不良心脏事件（MACE）的总体患病率较低，但此类患者通常会接受包括肌钙蛋白水平检测在内的实验室检查。更好地了解肌钙蛋白在SVT患者中的预后价值，可能有助于优化这些患者的处置。我们旨在比较接受血清肌钙蛋白检测（YesTrop）的SVT患者与未接受检测（NoTrop）的患者30天MACE发生率。
本项回顾性倾向评分匹配队列研究使用TriNetX数据库完成。TriNetX包含来自93个不同大型医疗保健机构（HCO）的数据，有超过1.32亿份患者记录，其中包括50多万名在急诊科诊断为SVT的患者。首次因SVT就诊于急诊科且接受或未接受肌钙蛋白检测的患者被纳入研究。有既往MACE病史的患者被排除。根据既往病史、分诊生命体征和实验室指标进行倾向评分匹配。使用TriNetX分析工具进行统计分析，包括风险分析和结局频率分析。
TriNetX数据库共产生225778例符合纳入标准的患者，倾向评分匹配后每组纳入31291例。平均年龄（±标准差[SD]）为58±18岁，17043例（54.5%）为女性，大多数为白人（69.8%）。MACE中风险差异最大的个体成分是急性心肌梗死，风险差异为-3.3%（95%CI-0.356至-0.299，p<0.001），心力衰竭风险差异为-3.8%（95%CI-0.414至-0.336，p<0.001）。NoTrop组的总MACE为10.5%（3816例事件），而YesTrop组为21.6%（7826例事件）（风险差异11.1%，95%CI-0.11至-0.116，P<0.001）。YesTrop组中高血压、糖尿病和慢性呼吸系统疾病（包括慢性阻塞性肺疾病、肺气肿和支气管炎）的医院诊断比例更高。
在这项涉及大量SVT患者的研究中，接受血清肌钙蛋白评估的患者30天MACE事件风险较高。然而，接受肌钙蛋白评估的患者合并症发生率也较高，这可能促使临床医生检查肌钙蛋白。在有进一步研究之前，临床医生在权衡对SVT患者开具肌钙蛋白检测的风险和益处时应运用临床判断力。
