Impact of the Introduction of High-Sensitive Troponin Assay in the Emergency Department: A Retrospective Study.
- 作者列表："Burgstaller JM","Held U","Gravestock I","Klauser BS","Gort LM","Melzer L","Hasler S","Bierreth TD","Müller SE","Steurer J","Wertli MM
BACKGROUND:Compared with troponin T/I test, the introduction of a high-sensitive (hs) troponin test may result in a higher proportion of positive test results in patients with chest pain and over-testing in patients without acute coronary syndrome. We assessed the impact of the introduction of the hs-troponin assay on the discharge diagnoses and the number of diagnostic tests in patients presenting with chest pain in a real-life setting in an emergency department. METHODS:Retrospective chart review of patients presenting with chest pain to one of the largest hospitals in Switzerland. We compared the standard troponin period (December 2009 to November 2010) with the hs-troponin period (December 2010 to December 2011). RESULTS:Data from 1274 patients (standard 597 [46.9%], hs-troponin 677 [53.1%]) were analyzed. The proportion of patients with non-ST-segment elevation myocardial infarction increased (hs-troponin 14.9%, compared with 9.7%); the proportion in unstable angina (1.5% to 4.0%) and other cardiac illnesses (8.1% to 11.7%) decreased. Although the proportion of noncardiac chest pain illnesses (67%) remained unchanged, the proportion of positive hs-troponin was higher (6.1% vs 2.0%). The average number of additional tests/person decreased in troponin-positive patients (2.0 to 1.7 test per patient; P = .02) and troponin-negative patients (3.1 to 2.8 tests; P < .0001). CONCLUSION:Although the introduction of the hs-troponin test resulted in a higher proportion of positive hs-troponin tests in patients with noncardiac chest pain, the average number of diagnostic tests decreased in patients with chest pain presenting to an emergency department, indicating an increased confidence of clinicians in their diagnosis.
背景: 与肌钙蛋白T/I检测相比，在胸痛患者中引入高敏 (hs) 肌钙蛋白检测可能导致更高比例的阳性检测结果，而在无急性冠脉综合征患者中过度检测。我们评估了引入hs-肌钙蛋白测定对急诊真实环境中出现胸痛患者的出院诊断和诊断试验数量的影响。 方法: 回顾性分析瑞士最大医院之一的胸痛患者。我们比较了标准肌钙蛋白期 (2009年12月至2010年11月) 和hs-肌钙蛋白期 (2010年12月至2011年12月)。 结果: 分析了1274例患者的数据 (标准597 [46.9%]，hs-肌钙蛋白677 [53.1%])。非ST段抬高型心肌梗死患者的比例增加 (hs-肌钙蛋白14.9%，与9.7% 相比); 不稳定型心绞痛 (1.5% ~ 4.0%) 和其他心脏疾病 (8.1% ~ 11.7%) 的比例降低。尽管非心源性胸痛疾病的比例 (67%) 保持不变，但hs-肌钙蛋白阳性的比例更高 (6.1% vs 2.0%)。肌钙蛋白阳性患者 (每例患者2.0 ~ 1.7次检测; P =.02) 和肌钙蛋白阴性患者 (3.1 ~ 2.8次检测; P < .0001) 的平均额外检测次数/人减少。 结论: 尽管hs-肌钙蛋白检测的引入导致非心源性胸痛患者hs-肌钙蛋白检测阳性的比例较高，但在急诊就诊的胸痛患者中，平均诊断检测次数减少，这表明临床医生对其诊断的信心增加。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.