Asunto(s)
Sustitución de Medicamentos/métodos , Enfermedad de Fabry/tratamiento farmacológico , Isoenzimas/administración & dosificación , alfa-Galactosidasa/administración & dosificación , Progresión de la Enfermedad , Monitoreo de Drogas/métodos , Ecocardiografía , Terapia de Reemplazo Enzimático/métodos , Enfermedad de Fabry/sangre , Enfermedad de Fabry/diagnóstico , Enfermedad de Fabry/fisiopatología , Tasa de Filtración Glomerular , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: To validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain. METHODS: International post hoc analysis of three prospective, observational studies from tertiary hospital emergency departments. The primary endpoint was cardiac death or acute myocardial infarction (AMI) within 24â hours of presentation, and the secondary endpoint was major adverse cardiac events (MACE) at 30â days. RESULTS: 15% of patients were diagnosed with non-ST elevation myocardial infarction (MI) on admission. The hsTnI algorithm classified 2506/3128 (80.1%) of patients as 'ruled out' with 50 (2.0%) missed MI. 943/3128 (30.1%) of patients had a troponin I level below the limit of detection on admission with 2 (0.2%) missed MI. For the hsTnT algorithm, 1794/3374 (53.1%) of patients were 'ruled out' with 7 (0.4%) missed MI. 490/3374 (14.5%) of patients had a troponin T below the limit of blank on admission with no MI. MACE at 30â days occurred in 10.7% and 8.5% of patients 'ruled out' defined by the hsTnI and hsTnT algorithms, respectively. CONCLUSIONS: The NICE algorithms could identify patients with low probability of AMI within 2â hours; however, neither strategy performed as predicted by the NICE diagnostic guidance model. Additionally, the rate of MACE at 30â days was sufficiently high that the algorithms should only be used as one component of a more extensive model of risk stratification. TRIAL REGISTRATION NUMBER: ACTRN12611001069943, NCT00470587; post-results.