在美国一个多地点队列中,性别特异性高敏肌钙蛋白 T 切点与总体切点相比,安全性相似,但疗效较低。

IF 3.4 3区 医学 Q1 EMERGENCY MEDICINE Academic Emergency Medicine Pub Date : 2024-09-02 DOI:10.1111/acem.15014
Connor M Montgomery, Nicklaus P Ashburn, Anna C Snavely, Brandon Allen, Robert Christenson, Troy Madsen, James McCord, Bryn Mumma, Tara Hashemian, Michael Supples, Jason Stopyra, R Gentry Wilkerson, Simon A Mahler
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This study aims to compare the safety and efficacy of sex-specific versus overall 99th percentile high-sensitivity cardiac troponin T (hs-cTnT) cut-points.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the STOP-CP cohort, which prospectively enrolled emergency department patients ≥ 21 years old with symptoms suggestive of ACS without ST-elevation on initial electrocardiogram across eight U.S. sites (January 25, 2017-September 6, 2018). Participants with both 0- and 1-h hs-cTnT measures less than or equal to the 99th percentile (sex-specific 22 ng/L for males, 14 ng/L for females; overall 19 ng/L) were classified into the rule-out group. The safety outcome was adjudicated cardiac death or myocardial infarction (MI) at 30 days. Efficacy was defined as the proportion classified to the rule-out group. McNemar's test and a generalized score statistic were used to compare rule-out and 30-day cardiac death or MI rates between strategies. 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引用次数: 0

摘要

背景:在诊断急性冠状动脉综合征(ACS)时,比较性别特异性和整体(非性别特异性)高敏心肌肌钙蛋白(hs-cTn)切点的性能的数据很有限。本研究旨在比较性别特异性与总体第99百分位数高敏心肌肌钙蛋白T(hs-cTnT)切点的安全性和有效性:我们对 STOP-CP 队列进行了二次分析,该队列在美国 8 个地点前瞻性地招募了年龄≥ 21 岁、症状提示 ACS 且初始心电图无 ST 抬高的急诊科患者(2017 年 1 月 25 日至 2018 年 9 月 6 日)。0小时和1小时hs-cTnT测量值均小于或等于第99百分位数(性别特异性为男性22纳克/升,女性14纳克/升;总体19纳克/升)的参与者被归入排除组。安全性结果为 30 天内判定的心源性死亡或心肌梗死(MI)。疗效定义为归入排除组的比例。采用 McNemar 检验和广义记分统计来比较不同策略的排除率和 30 天的心脏死亡或心肌梗死率。净再分类改善(NRI)指数用于进一步比较绩效:本次分析共纳入 1430 名患者,其中 45.8%(655/1430)为女性;平均年龄(± SD)为 57.6±12.8 岁。在 30 天内,12.8% 的患者(183/1430)发生了心源性死亡或心肌梗死。使用性别特异性切点与总体切点相比,排除率更低(70.6% [1010/1430] vs. 72.5% [1037/1430];P = 0.003)。在被排除的患者中,采用性别特异性策略(2.4% [24/1010])与整体策略(2.3% [24/1037])的 30 天心脏死亡或心肌梗死率相似(p = 0.79)。在心源性死亡或心肌梗死患者中,性别特异性切点与整体切点相比,正确地重新分类了三名女性,错误地重新分类了三名男性。性别特异性策略净导致 27 名患者被错误地重新分类到规则入组。这导致NRI为-2.2%(95% CI -5.1%至0.8%):结论:与整体切点策略相比,性别特异性 hs-cTnT 切点减少了被排除的患者人数,但安全性却没有提高。
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Sex-specific high-sensitivity troponin T cut-points have similar safety but lower efficacy than overall cut-points in a multisite U.S. cohort.

Background: Data comparing the performance of sex-specific to overall (non-sex-specific) high-sensitivity cardiac troponin (hs-cTn) cut-points for diagnosing acute coronary syndrome (ACS) are limited. This study aims to compare the safety and efficacy of sex-specific versus overall 99th percentile high-sensitivity cardiac troponin T (hs-cTnT) cut-points.

Methods: We conducted a secondary analysis of the STOP-CP cohort, which prospectively enrolled emergency department patients ≥ 21 years old with symptoms suggestive of ACS without ST-elevation on initial electrocardiogram across eight U.S. sites (January 25, 2017-September 6, 2018). Participants with both 0- and 1-h hs-cTnT measures less than or equal to the 99th percentile (sex-specific 22 ng/L for males, 14 ng/L for females; overall 19 ng/L) were classified into the rule-out group. The safety outcome was adjudicated cardiac death or myocardial infarction (MI) at 30 days. Efficacy was defined as the proportion classified to the rule-out group. McNemar's test and a generalized score statistic were used to compare rule-out and 30-day cardiac death or MI rates between strategies. Net reclassification improvement (NRI) index was used to further compare performance.

Results: This analysis included 1430 patients, of whom 45.8% (655/1430) were female; the mean ± SD age was 57.6 ± 12.8 years. At 30 days, cardiac death or MI occurred in 12.8% (183/1430). The rule-out rate was lower using sex-specific versus overall cut-points (70.6% [1010/1430] vs. 72.5% [1037/1430]; p = 0.003). Among rule-out patients, the 30-day cardiac death or MI rates were similar for sex-specific (2.4% [24/1010]) vs. overall (2.3% [24/1037]) strategies (p = 0.79). Among patients with cardiac death or MI, sex-specific versus overall cut-points correctly reclassified three females and incorrectly reclassified three males. The sex-specific strategy resulted in a net of 27 patients being incorrectly reclassified into the rule-in group. This led to an NRI of -2.2% (95% CI -5.1% to 0.8%).

Conclusions: Sex-specific hs-cTnT cut-points resulted in fewer patients being ruled out without an improvement in safety compared to the overall cut-point strategy.

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来源期刊
Academic Emergency Medicine
Academic Emergency Medicine 医学-急救医学
CiteScore
7.60
自引率
6.80%
发文量
207
审稿时长
3-8 weeks
期刊介绍: Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.
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