Elevated high-sensitive cardiac troponin T in emergency department patients: insights from a retrospective descriptive cohort study.

IF 2 Q2 EMERGENCY MEDICINE International Journal of Emergency Medicine Pub Date : 2024-10-07 DOI:10.1186/s12245-024-00735-w
Finn Syryca, Bernhard Haller, Lisa Schmid, Christiane Kallweit, Philipp Nicol, Teresa Trenkwalder, Karl-Georg Kanz, Anja Haas, Michael Dommasch
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Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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急诊科患者高敏心肌肌钙蛋白 T 升高:一项回顾性描述性队列研究的启示。
背景:高敏心肌肌钙蛋白 T(hs-cTnT)评估是德国急诊科(ED)的常规检查项目。然而,关于大量急诊科患者的病理 hs-cTnT 水平及其后续临床结果的数据却很有限: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 Klinikum rechts der Isar 跨学科急诊科就诊的 141 892 名患者。排除了诊断为外伤的患者,重点关注 hs-cTnT 水平升高的患者。根据国际医学程序分类法(ICPM),这些患者被分为三组:未接受冠状动脉造影术(NCA)的 hs-cTnT 升高患者、接受诊断性冠状动脉造影术(DCA)的患者和接受经皮冠状动脉介入治疗(PCI)的患者。这项研究的目的是描述大型急诊科患者队列的特征,并评估他们随后的临床结果:经过最初的曼彻斯特分诊系统(MTS)分类后,32.6%(46.307/141.892)的患者被确定为非创伤病例。其中,9.9%(4.587/46.307)的 hs-cTnT 水平超过 14 纳克/升。在这个子集中,70.4%(3.230/4.587)的患者没有接受冠状动脉造影术,15.4%(705/4.587)的患者接受了DCA,14.2%(652/4.587)的患者接受了PCI。与 DCA 组(18.3%,113/705)或 NCA 组(5.7%,159/3230)相比,PCI 组(28.0%,160/652)胸痛发生率更高:在我们的回顾性描述性研究中,hs-cTnT 升高且未接受冠状动脉造影术的急诊患者面临较高的院内死亡风险。鉴于急诊科主诉的异质性,识别高危患者可能会给治疗医生带来挑战。
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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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