肌钙蛋白
肌钙蛋白T
肌钙蛋白I
急诊医学
急性冠脉综合征
作者
Olatunde Ola,Ashok Akula,Laura De Michieli,Marshall Dworak,Erika Crockford,Ronstan Lobo,Nicholas Rastas,Jonathan D. Knott,Ramila A. Mehta,David O. Hodge,Eric D. Grube,Swetha Karturi,Scott Wohlrab,Tahir Tak,Charles Cagin,Rajiv Gulati,Allan S. Jaffe,Yader Sandoval
标识
DOI:10.1016/j.jacc.2021.04.050
摘要
Abstract Background Limited U.S. data exist regarding high-sensitivity cardiac troponin (cTn) implementation. Objectives This study sought to evaluate the impact of high-sensitivity cardiac troponin T (cTnT) implementation. Methods Observational U.S. cohort study of emergency department (ED) patients undergoing measurement of cTnT during the transition from 4th (pre-implementation March 12, 2018, to September 11, 2018) to 5th generation (Gen) cTnT (post-implementation September 12, 2018, to March 11, 2019). Diagnoses were adjudicated following the Fourth Universal Definition of Myocardial Infarction (MI). Resources evaluated included length of stay, hospitalizations, and cardiac testing. Results In this study, 3,536 unique patients were evaluated, including 2,069 and 2,491 ED encounters pre- and post-implementation. Compared with 4th Gen cTnT, encounters with ≥1 cTnT >99th percentile increased using 5th Gen cTnT (15% vs. 47%; p Conclusions High-sensitivity cTnT implementation resulted in a marked increase in myocardial injury and MI, particularly in women and patients with type 2 MI. Despite this, except for angiography, overall resource use did not increase. Among those without cTnT increases, there were more ED discharges and fewer cardiac tests.
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