Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction.
Eur Heart J Acute Cardiovasc Care
; 8(4): 299-308, 2019 Jun.
Article
em En
| MEDLINE
| ID: mdl-29199427
ABSTRACT
OBJECTIVE:
The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction. METHODS ANDRESULTS:
All prehospital emergency medical service vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction. During the study period, 1 June 2012-30 November 2015, prehospital point-of-care cardiac troponin T measurements were performed in a total of 19,615 cases seen by the emergency medical service and 18,712 point-of-care cardiac troponin T measurements in 15,781 individuals were matched with an admission. A final diagnosis of acute myocardial infarction was confirmed in 2187 cases and a total of 2150 point-of-care cardiac troponin T measurements (11.0%) had a value ≥50 ng/l, including 966 with acute myocardial infarction (sensitivity 44.2%, specificity 92.8%). Patients presenting with a prehospital point-of-care cardiac troponin T value ≥50 ng/l had a one-year mortality of 24% compared with 4.8% in those with values <50 ng/l, log-rank p<0.001. The following variables showed the strongest association with mortality in multivariableanalysis:
point-of-care cardiac troponin T≥50 ng/l (hazard ratio 2.10, 95% confidence interval 1.90-2.33), congestive heart failure (hazard ratio 1.93, 95% confidence interval 1.74-2.14), diabetes mellitus (hazard ratio 1.42, 95% confidence interval 1.27-1.59) and age, one-year increase (hazard ratio 1.08, 95% confidence interval 1.08-1.09).CONCLUSIONS:
Patients with suspected acute myocardial infarction and a prehospital point-of-care cardiac troponin T ≥50 ng/l have a poor prognosis irrespective of the final diagnosis. Routine troponin measurement in the prehospital setting has a high predictive value and can be used to identify high-risk patients even before hospital arrival so that they may be re-routed directly for advanced care at an invasive centre.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Medição de Risco
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Sistemas Automatizados de Assistência Junto ao Leito
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Troponina T
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Serviços Médicos de Emergência
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Infarto do Miocárdio
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Eur Heart J Acute Cardiovasc Care
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Dinamarca