一个单一的高灵敏性心脏热素T策略来排除心肌梗塞
Patrik Gilje1, Moman A Mohammad1, Andreas Roos2,3
1Lund University, Skåne University Hospital, Department of Cardiology, Lund, Sweden.
Emergency medicine international
|April 3, 2024
概括
9 ng/L的高灵敏性心脏热素T (hs-cTnT) 的较高值可以在急诊室患者中安全排除急性心肌梗塞 (AMI). 这种方法比目前的方法能识别出更多的低风险个体,提高了诊断胸痛的效率.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 生物标志物研究 生物标志物研究
背景情况:
- 在急诊室 (ED) 排除急性心肌梗塞 (AMI) 存在诊断挑战.
- 目前的指导方针建议使用高灵敏性心脏托罗素T (hs-cTnT) 在呈现时低于5 ng/L或6 ng/L的水平,以排除AMI.
- 人们认识到需要在ED中更有效,更准确的AMI诊断值.
研究的目的:
- 确定是否可以安全地使用更高的hs-cTnT值来排除ED中的AMI.
- 评估高hs-cTnT度的负预测值 (NPV) 对于AMI和全因死亡.
- 为了比较较高的hs-cTnT值与现有的值的有效性.
主要方法:
- 分析了24973名患有胸痛的ED患者的衍生队列.
- 确定了最高的0小时hs-cTnT度,在AMI/30天全因死亡中达到≥99.5%的NPV.
- 在两个独立的队列中进行了验证,共计132,021名和1167名ED胸痛患者.
主要成果:
- 在0小时hs-cTnT值<9 ng/L时,主要终点的NPV为99.6%.
- 这种<9 ng/L的切线将59.7%的患者确定为低风险,明显高于<5 ng/L (35.8%) 和<6 ng/L (43.9%) 的切线.
- 在验证队列中观察到类似的表现,在特定的子组中有效性得到改善,例如那些后来hs-cTnT测量或非高风险配置文件的子组.
结论:
- 0小时的hs-cTnT截止值<9 ng/L可以安全地排除大多数胸痛患者的AMI和30天死亡.
- 这种更高的门代表了与当前<5 ng/L和<6 ng/L截止值相比,识别低风险患者的更有效的策略.
- 该研究提供了优化急诊部AMI排除协议的证据.
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