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1.
West J Emerg Med ; 23(3): 439-442, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35679492

RESUMO

INTRODUCTION: Emergency departments (ED) are rapidly replacing conventional troponin assays with high-sensitivity troponin tests. We sought to evaluate emergency physician utilization of troponin tests before and after high-sensitivity troponin introduction in our ED. METHODS: We retrospectively examined 9,477 ED encounters, identifying the percentage in which physicians ordered a serum troponin both before and after our institution adopted a high-sensitivity troponin test. RESULTS: After introduction of high-sensitivity troponin testing, the percentage of ED encounters in which physicians ordered troponin studies decreased (28.3% before vs 22% after; P <.001), with the drop most pronounced in admitted patients (decrease of 10.9% [95% confidence interval [CI]: 7.3%-14.5%] in admitted patients vs decrease of 3.6% [95% CI: 1.7%-5.4%] in discharged patients; P<.001) CONCLUSION: Introduction of high-sensitivity troponin testing was associated with a decrease in troponin ordering. While the reasons for this are unclear, it is possible that physicians became more selective in their ordering behavior because of the lower specificity of high-sensitivity troponin.


Assuntos
Médicos , Troponina , Biomarcadores , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos
2.
J Am Coll Cardiol ; 79(23): 2333-2348, 2022 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-35680185

RESUMO

Existing assessment pathways for acute chest pain are often resource-intensive, prolonged, and expensive. In this review, the authors describe existing chest pain pathways and current issues at the patient and system level, and provide an overview of recent advances in chest pain research that could inform improved outcomes for both patients and health systems. There are multiple avenues to improve existing models of chest pain care, including novel risk stratification pathways incorporating highly sensitive point-of-care troponin assays; new devices available before first medical contact that could allow clinicians to access vital signs and electrocardiogram data; artificial intelligence and precision medicine tools that may guide indications for further testing; and strategies to improve hospital benchmarking and performance monitoring to standardize care. Improving the speed and accuracy of chest pain diagnosis and management should be a priority for researchers and is likely to translate to substantive benefits for patients and health systems.


Assuntos
Inteligência Artificial , Dor no Peito , Biomarcadores , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Dor no Peito/terapia , Eletrocardiografia , Serviço Hospitalar de Emergência , Humanos , Troponina
4.
BMC Infect Dis ; 22(1): 552, 2022 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-35715729

RESUMO

BACKGROUND AND AIMS: Initial reports on US COVID-19 showed different outcomes in different races. In this study we use a diverse large cohort of hospitalized COVID-19 patients to determine predictors of mortality. METHODS: We analyzed data from hospitalized COVID-19 patients (n = 5852) between March 2020- August 2020 from 8 hospitals across the US. Demographics, comorbidities, symptoms and laboratory data were collected. RESULTS: The cohort contained 3,662 (61.7%) African Americans (AA), 286 (5%) American Latinx (LAT), 1,407 (23.9%), European Americans (EA), and 93 (1.5%) American Asians (AS). Survivors and non-survivors mean ages in years were 58 and 68 for AA, 58 and 77 for EA, 44 and 61 for LAT, and 51 and 63 for AS. Mortality rates for AA, LAT, EA and AS were 14.8, 7.3, 16.3 and 2.2%. Mortality increased among patients with the following characteristics: age, male gender, New York region, cardiac disease, COPD, diabetes mellitus, hypertension, history of cancer, immunosuppression, elevated lymphocytes, CRP, ferritin, D-Dimer, creatinine, troponin, and procalcitonin. Use of mechanical ventilation (p = 0.001), shortness of breath (SOB) (p < 0.01), fatigue (p = 0.04), diarrhea (p = 0.02), and increased AST (p < 0.01), significantly correlated with death in multivariate analysis. Male sex and EA and AA race/ethnicity had higher frequency of death. Diarrhea was among the most common GI symptom amongst AAs (6.8%). When adjusting for comorbidities, significant variables among the demographics of study population were age (over 45 years old), male sex, EA, and patients hospitalized in New York. When adjusting for disease severity, significant variables were age over 65 years old, male sex, EA as well as having SOB, elevated CRP and D-dimer. Glucocorticoid usage was associated with an increased risk of COVID-19 death in our cohort. CONCLUSION: Among this large cohort of hospitalized COVID-19 patients enriched for African Americans, our study findings may reflect the extent of systemic organ involvement by SARS-CoV-2 and subsequent progression to multi-system organ failure. High mortality in AA in comparison with LAT is likely related to high frequency of comorbidities and older age among AA. Glucocorticoids should be used carefully considering the poor outcomes associated with it. Special focus in treating patients with elevated liver enzymes and other inflammatory biomarkers such as CRP, troponin, ferritin, procalcitonin, and D-dimer are required to prevent poor outcomes.


Assuntos
COVID-19 , Afro-Americanos , Idoso , Biomarcadores , Diarreia , Ferritinas , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina , Estudos Retrospectivos , SARS-CoV-2 , Troponina
7.
Int Clin Psychopharmacol ; 37(4): 179-181, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35661661

RESUMO

Clozapine-induced myocarditis and pericarditis are uncommon adverse effects of clozapine treatment. However, in most cases, they lead to clozapine discontinuation. Here, we describe a case of successful clozapine rechallenge after clozapine-induced myopericarditis. The patient, a 31-year-old male with treatment-resistant schizophrenia (TRS), developed dyspnea on exertion and chest pain on day 19 after the start of clozapine titration. An electrocardiogram (ECG) showed widespread, mild, convex ST interval elevation. While troponin levels were mildly elevated, the echocardiogram was unremarkable. A myopericarditis diagnosis was formulated, and clozapine was stopped, with a progressive resolution of clinical, laboratory and ECG abnormalities. After 6 months, a rechallenge with clozapine was attempted. A very slow titration scheme was adopted, along with close monitoring of clinical, laboratory and ECG parameters. Clozapine target dose was reached without the occurrence of any abnormality. Given the unique role of clozapine in the management of TRS, clozapine rechallenge may be considered after pericarditis, even with troponin levels elevation. Further studies are needed to update current clinical guidelines.


Assuntos
Antipsicóticos , Clozapina , Miocardite , Pericardite , Adulto , Antipsicóticos/efeitos adversos , Clozapina/efeitos adversos , Humanos , Masculino , Miocardite/induzido quimicamente , Miocardite/diagnóstico , Pericardite/induzido quimicamente , Pericardite/complicações , Pericardite/diagnóstico , Troponina/efeitos adversos
9.
Anaesthesia ; 77(7): 772-784, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35607911

RESUMO

Cardiovascular complications due to COVID-19, such as right ventricular dysfunction, are common. The combination of acute respiratory distress syndrome, invasive mechanical ventilation, thromboembolic disease and direct myocardial injury creates conditions where right ventricular dysfunction is likely to occur. We undertook a prospective, multicentre cohort study in 10 Scottish intensive care units of patients with COVID-19 pneumonitis whose lungs were mechanically ventilated. Right ventricular dysfunction was defined as the presence of severe right ventricular dilation and interventricular septal flattening. To explore the role of myocardial injury, high-sensitivity troponin and N-terminal pro B-type natriuretic peptide plasma levels were measured in all patients. We recruited 121 patients and 118 (98%) underwent imaging. It was possible to determine the primary outcome in 112 (91%). Severe right ventricular dilation was present in 31 (28%), with interventricular septal flattening present in nine (8%). Right ventricular dysfunction (the combination of these two parameters) was present in seven (6%, 95%CI 3-13%). Thirty-day mortality was 86% in those with right ventricular dysfunction as compared with 45% in those without (p = 0.051). Patients with right ventricular dysfunction were more likely to have: pulmonary thromboembolism (p < 0.001); higher plateau airway pressure (p = 0.048); lower dynamic compliance (p = 0.031); higher plasma N-terminal pro B-type natriuretic peptide levels (p = 0.006); and raised plasma troponin levels (p = 0.048). Our results demonstrate a prevalence of right ventricular dysfunction of 6%, which was associated with increased mortality (86%). Associations were also observed between right ventricular dysfunction and aetiological domains of: acute respiratory distress syndrome; ventilation; thromboembolic disease; and direct myocardial injury, implying a complex multifactorial pathophysiology.


Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Disfunção Ventricular Direita , COVID-19/complicações , Estudos de Coortes , Humanos , Pulmão/diagnóstico por imagem , Peptídeo Natriurético Encefálico , Estudos Prospectivos , Respiração Artificial/efeitos adversos , Troponina , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/etiologia
10.
Cardiovasc Toxicol ; 22(7): 663-675, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35567651

RESUMO

Mitochondrial dysfunction may lead to cardiomyocyte death in trastuzumab (TZM)-induced cardiotoxicity. Accordingly, this study was designed to evaluate the mitochondrial protective effects of curcumin, chrysin and thymoquinone alone in TZM-induced cardiotoxicity in the rats. Forty-eight male adult Wistar rats were divided into eight groups: control group (normal saline), TZM group (2.5 mg/kg I.P. injection, daily), TZM + curcumin group (10 mg/kg, I.P. injection, daily), TZM + chrysin (10 mg/kg, I.P. injection, daily), TZM + thymoquinone (0.5 mg/kg, I.P. injection, daily), curcumin group (10 mg/kg, I.P. injection, daily), chrysin group (10 mg/kg, I.P. injection, daily) and thymoquinone group (10 mg/kg, I.P. injection, daily). Blood and tissue were collected on day 11 and used for assessment of creatine phosphokinase, lactate dehydrogenase (LDH), troponin, malondialdehyde (MDA) amount, glutathione levels and mitochondrial toxicity parameters. TZM increased mitochondrial impairments (reactive oxygen species formation, mitochondrial swelling, mitochondrial membrane potential collapse and decline in succinate dehydrogenase activity) and histopathological alterations (hypertrophy, enlarged cell, disarrangement, myocytes degeneration, infiltration of fat in some areas, hemorrhage and focal vascular thrombosis) in rat heart. As well as TZM produced a significant increase in the level of CK, LDH, troponin, MDA, glutathione disulfide. In most experiments, the co-injection of curcumin, chrysin and thymoquinone with TZM restored the level of CK, LDH, troponin, MDA, GSH, mitochondrial impairments and histopathological alterations. The study revealed the cardioprotective effects of curcumin, chrysin and thymoquinone against TZM-induced cardiotoxicity which could be attributed to their antioxidant and mitochondrial protection activities.


Assuntos
Cardiotoxicidade , Curcumina , Animais , Antioxidantes/farmacologia , Benzoquinonas , Cardiotoxicidade/prevenção & controle , Curcumina/farmacologia , Doxorrubicina/farmacologia , Flavonoides , Glutationa/metabolismo , Masculino , Mitocôndrias/metabolismo , Estresse Oxidativo , Ratos , Ratos Wistar , Trastuzumab/toxicidade , Troponina/farmacologia
11.
Open Heart ; 9(1)2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35606046

RESUMO

BACKGROUND: The clinical significance of peak troponin levels following ST-elevation myocardial infarction (STEMI) has not been definitively established. The purpose of this study was to examine the relationship between peak high-sensitivity cardiac troponin T (hs-cTnT) and all-cause mortality at 30 days and 1 year, and left ventricular ejection fraction (LVEF) in STEMI. METHODS: A single-centre retrospective observational study was conducted of all patients with STEMI between January 2015 and December 2017. Demographics and clinical data were obtained through electronic patient records. Standard Bayesian statistics were employed for analysis. RESULTS: During the study period, 568 patients presented with STEMI. The mean age was 63.6±12 years and 76.4% were men. Of these, 535 (94.2%) underwent primary percutaneous coronary intervention, 12 (2.1%) underwent urgent coronary artery bypass and 21 (3.7%) were treated medically. Mean peak hs-cTnT levels were significantly higher in those who died within 30 days compared with those who survived (12 238 ng/L vs 4657 ng/L, respectively; p=0.004). Peak hs-cTnT levels were also significantly higher in those who died within 1 year compared with those who survived (10 319 ng/L vs 4622 ng/L, respectively; p=0.003). The left anterior descending artery was associated with the highest hs-cTnT and was the most common culprit in those who died at 1 year. An inverse relationship was demonstrated between peak hs-cTnT and LVEF (Pearson's R=0.379; p<0.00001). CONCLUSIONS: In STEMI, those who died at 30 days and 1 year had significantly higher peak troponin levels than those who survived. Peak troponin is also inversely proportional to LVEF with higher troponins associated with lower LVEF.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , Teorema de Bayes , Biomarcadores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Volume Sistólico , Troponina , Troponina T , Função Ventricular Esquerda
13.
Oxid Med Cell Longev ; 2022: 5029853, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35535358

RESUMO

Background: Valvular heart disease (VHD) is a major contributor to loss of physical function and longevity. Oxidative stress is one of the key causative factors involved in heart disease including VHD. Here, we aimed to illuminate the role and relation of oxidative stress to the VHD risk markers in the human population. Materials and Methods: 150 VHD patients and 103 healthy individuals as control were selected for the study and were divided into three groups: the aortic valve, mitral valve, and combined disease based on valvular calcification. Results: Our results demonstrated enhanced oxidative stress in the VHD condition, as we found elevated levels of reactive oxygen species (ROS) at the serum, supported by an increased level of thiobarbituric acid reactive substances (TBARs) in the cardiac valvular tissues of the VHD patients. In contrast, we experienced declined antioxidants including Super Oxide Dismutase (SOD), catalase (CAT), and peroxidase (POD) activities. Concurrently, increasing levels of C-reactive protein (CRP), high-sensitivity cardiac troponin I (hs-cTnI), and high-sensitivity cardiac troponin T (hs-cTnT) were detected in the aortic, mitral, and combined disease condition, suggesting a key association of oxidative stress to VHD conditions. Furthermore, regression analysis validated a key association between the impairment of the redox system (ROS and antioxidant enzyme activities) and VHD condition. Conclusion: Taken together, dysregulated oxidative stress contributes to the progression of VHD via positively correlating with CRP, hs-TnI, and hs-TnT level.


Assuntos
Proteína C-Reativa , Doenças das Valvas Cardíacas , Humanos , Estresse Oxidativo , Espécies Reativas de Oxigênio , Troponina
14.
Saudi Med J ; 43(5): 526-529, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35537736

RESUMO

OBJECTIVES: To assess the appropriateness of troponin testing in the Emergency Department (ED) at King Saud Medical City, Riyadh, Saudi Arabia. METHODS: This record-based cross-sectional study examined the electronic records of adult patients who underwent a troponin test following admission to hospital's ED from January to March 2020. RESULTS: A total of 367 troponin tests were ordered for 233 patients. Majority of these orders were appropriate (55%) while the remaining (45%) were adjudged as inappropriate. Among the inappropriate orders, majority were single (61%) compared to serial ones (39%). Overall, there were 166 inappropriate orders and the estimated direct monthly cost for inappropriate testing was 49,800 Saudi Riyals in the emergency department alone. CONCLUSION: Approximately half of the troponin tests ordered in the ED were inappropriate. The overall financial burden of inappropriate testing greatly impacts patient management and resource utilization. These findings emphasize the pressing need for institutional clinical guidelines to guide appropriate use of troponin testing.


Assuntos
Serviço Hospitalar de Emergência , Troponina , Adulto , Estudos Transversais , Humanos , Arábia Saudita , Centros de Atenção Terciária
15.
BMJ Case Rep ; 15(5)2022 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-35613832

RESUMO

A man in his mid-50s presented with palpitations, chest pain and syncope. After initial workup for a non-ST elevation myocardial infarction, a CT scan revealed metastatic melanoma. The malignancy was infiltrating his right ventricle, resulting in recurrent ventricular tachycardia. Although initially hard to manage, his arrhythmias were eventually controlled with medication. Unfortunately, despite an initial response to immunotherapy, he died six months after diagnosis.Cardiac metastases are rare, but melanoma has a high predication for metastasising to the heart and a small number of cases of such metastases causing ventricular arrhythmias have previously been reported. This case shows the importance of concurrent investigations when patients report multiple, seemingly unrelated symptoms as a unifying diagnosis may be uncovered.


Assuntos
Melanoma , Segunda Neoplasia Primária , Taquicardia Ventricular , Arritmias Cardíacas/complicações , Coração , Humanos , Masculino , Melanoma/complicações , Segunda Neoplasia Primária/complicações , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiologia , Troponina
16.
Crit Pathw Cardiol ; 21(2): 73-76, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35604774

RESUMO

BACKGROUND: To assess emergency department (ED) clinician perception of patient risk, we measured willingness to discharge patients categorized as increased risk by traditional risk stratification modalities for acute coronary syndrome but low risk by a validated high-sensitivity troponin accelerated diagnostic protocol (HST-ADP). METHODS: This was a cross-sectional descriptive survey study distributed to ED clinicians at an urban academic medical center. Four clinical vignettes classified hypothetical patients as low risk for 30-day acute coronary syndrome according to the 0-/1-hour HST-ADP. Vignettes additionally identified patients with History, Electrocardiogram, Age, Risk factors, and initial Troponin (HEART) scores of 4 or 6 (2 cases each). One patient in each subset had preexisting coronary artery disease (CAD). ED clinicians self-reported willingness to discharge patients from the ED on a 10-point Likert scale. RESULTS: Among 66 eligible participants, 36 (55%) participated in the survey. ED clinicians reported a mean willingness to discharge patients of 6.07 (95% confidence interval, 5.34-6.80). They reported higher mean willingness to discharge patients with HEART scores of 4 compared with those with HEART scores of 6 (mean difference, 3.61; 95% confidence interval, 2.19-5.03). There were no differences in willingness to discharge regarding presence or absence of CAD or between clinician types (attending, resident, advanced practice provider). CONCLUSIONS: ED clinicians accustomed to the HEART Pathway demonstrated limited willingness to discharge patients from the ED categorized as moderate risk by the HEART score despite simultaneous classification as low risk by the 0-/1-hour HST-ADP. Willingness to discharge was higher with lower HEART scores but not affected by the presence of CAD and did not vary between clinician types.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Difosfato de Adenosina , Dor no Peito/diagnóstico , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Estudos Transversais , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência , Humanos , Percepção , Medição de Risco/métodos , Fatores de Risco , Troponina
17.
Artigo em Inglês | MEDLINE | ID: mdl-35564577

RESUMO

Patients undergoing major surgery have a substantial risk of cardiovascular events during the perioperative period. Despite the introduction of several risk scores based on medical history, classical risk factors and non-invasive cardiac tests, the possibility of predicting cardiovascular events in patients undergoing non-cardiac surgery remains limited. The cardiac-specific biomarkers, natriuretic peptides (NPs) and cardiac troponins (cTn) have been proposed as additional tools for risk prediction in the perioperative period. This review paper aims to discuss the value of preoperative levels and perioperative changes in cardiac-specific biomarkers to predict adverse outcomes in patients undergoing major non-cardiac surgery. Based on several prospective observational studies and six meta-analyses, some guidelines recommended the measurement of NPs to refine perioperative cardiac risk estimation in patients undergoing non-cardiac surgery. More recently, several studies reported a higher mortality in surgical patients presenting an elevation in high-sensitivity cardiac troponin T and I, especially in elderly patients or those with comorbidities. This evidence should be considered in future international guidelines on the evaluation of perioperative risk in patients undergoing major non-cardiac surgery.


Assuntos
Doenças Cardiovasculares , Troponina , Idoso , Biomarcadores , Doenças Cardiovasculares/etiologia , Humanos , Peptídeos Natriuréticos , Estudos Observacionais como Assunto , Medição de Risco
18.
Cardiovasc Diabetol ; 21(1): 77, 2022 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-35570280

RESUMO

BACKGROUND: The inflammatory response occurring in acute myocardial infarction (AMI) has been proposed as a potential pharmacological target. Sodium-glucose co-transporter 2 inhibitors (SGLT2-I) currently receive intense clinical interest in patients with and without diabetes mellitus (DM) for their pleiotropic beneficial effects. We tested the hypothesis that SGLT2-I have anti-inflammatory effects along with glucose-lowering properties. Therefore, we investigated the link between stress hyperglycemia, inflammatory burden, and infarct size in a cohort of type 2 diabetic patients presenting with AMI treated with SGLT2-I versus other oral anti-diabetic (OAD) agents. METHODS: In this multicenter international observational registry, consecutive diabetic AMI patients undergoing percutaneous coronary intervention (PCI) between 2018 and 2021 were enrolled. Based on the presence of anti-diabetic therapy at the admission, patients were divided into those receiving SGLT2-I (SGLT-I users) versus other OAD agents (non-SGLT2-I users). The following inflammatory markers were evaluated at different time points: white-blood-cell count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-platelet ratio (NPR), and C-reactive protein. Infarct size was assessed by echocardiography and by peak troponin levels. RESULTS: The study population consisted of 583 AMI patients (with or without ST-segment elevation): 98 SGLT2-I users and 485 non-SGLT-I users. Hyperglycemia at admission was less prevalent in the SGLT2-I group. Smaller infarct size was observed in patients treated with SGLT2-I compared to non-SGLT2-I group. On admission and at 24 h, inflammatory indices were significantly higher in non-SGLT2-I users compared to SGLT2-I patients, with a significant increase in neutrophil levels at 24 h. At multivariable analysis, the use of SGLT2-I was a significant predictor of reduced inflammatory response (OR 0.457, 95% CI 0.275-0.758, p = 0.002), independently of age, admission creatinine values, and admission glycemia. Conversely, peak troponin values and NSTEMI occurrence were independent predictors of a higher inflammatory status. CONCLUSIONS: Type 2 diabetic AMI patients receiving SGLT2-I exhibited significantly reduced inflammatory response and smaller infarct size compared to those receiving other OAD agents, independently of glucose-metabolic control. Our findings are hypothesis generating and provide new insights on the cardioprotective effects of SGLT2-I in the setting of coronary artery disease. TRIAL REGISTRATION: Data are part of the ongoing observational registry: SGLT2-I AMI PROTECT. CLINICALTRIALS: gov Identifier: NCT05261867.


Assuntos
Diabetes Mellitus Tipo 2 , Hiperglicemia , Infarto do Miocárdio , Intervenção Coronária Percutânea , Inibidores do Transportador 2 de Sódio-Glicose , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hiperglicemia/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Sistema de Registros , Transportador 2 de Glucose-Sódio , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Troponina/metabolismo
19.
J Emerg Med ; 62(5): 657-667, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35382958

RESUMO

BACKGROUND: The new high-sensitivity cardiac troponin T (hs-cTnT) is now widely used in the United States. OBJECTIVES: We aimed to examine outcomes associated with the introduction of the new 5th generation hs-cTnT assay among patients presenting to the emergency department (ED) with cardiovascular (CV) disorders. METHODS: The study comprised 5377 patients presenting to the ED with CV disorders between January and September 2018. Outcomes included rates of direct ED discharge, cardiac testing/procedures, and mortality. CV indications for troponin testing were categorized as rule-out acute coronary syndrome (RO-ACS) and other-CV (O-CV). RESULTS: Mean age was 62 ± 17 years, and 47% were female. Demographics and medical history did not differ significantly between the troponin groups. The use of hs-cTnT was associated with increased rates of direct discharge from the ED in the RO-ACS (48% vs. 37%; p < 0.01), but not in the O-CV (25% vs. 25%) cohort. Cardiac tests/procedures were more often performed after hs-cTnT vs. cTnT testing in both cohorts (45% vs. 41% for RO-ACS, and 33% vs. 28% for O-CV; p < 0.05 for both). Multivariate analysis demonstrated that hs-cTnT was not associated with a significant increase in postdischarge mortality in both cohorts (RO-ACS: hazard ratio = 1.47 [p = 0.13], O-CV: hazard ratio = 0.97 [p = 0.87]). CONCLUSIONS: Among patients with RO-ACS, hs-cTnT implementation resulted in increased rates of direct home discharge from the ED, without a significant increase in postdischarge mortality. Among patients presenting with O-CV indication, hs-cTnT implementation resulted in increased rates of cardiac testing procedures without an effect of ED discharge rates or long-term mortality.


Assuntos
Síndrome Coronariana Aguda , Doenças Cardiovasculares , Síndrome Coronariana Aguda/diagnóstico , Assistência ao Convalescente , Idoso , Biomarcadores , Doenças Cardiovasculares/diagnóstico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Troponina , Troponina T
20.
Eur Heart J Acute Cardiovasc Care ; 11(5): 418-427, 2022 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-35373255

RESUMO

AIMS: Most rural hospitals and general practices in New Zealand (NZ) are reliant on point-of-care troponin. A rural accelerated chest pain pathway (RACPP), combining an electrocardiogram (ECG), a structured risk score (Emergency Department Assessment of Chest Pain Score), and serial point-of-care troponin, was designed for use in rural hospital and primary care settings across NZ. The aim of this study was to evaluate the safety and effectiveness of the RACPP. METHODS AND RESULTS: A prospective multi-centre evaluation following implementation of the RACPP was undertaken from 1 July 2018 to 31 December 2020 in rural hospitals, rural and urban general practices, and urgent care clinics. The primary outcome measure was the presence of 30-day major adverse cardiac events (MACEs) in low-risk patients. The secondary outcome was the percentage of patients classified as low-risk that avoided transfer or were eligible for early discharge. There were 1205 patients enrolled in the study. 132 patients were excluded. Of the 1073 patients included in the primary analysis, 474 (44.0%) patients were identified as low-risk. There were no [95% confidence interval (CI): 0-0.3%] MACE within 30 days of the presentation among low-risk patients. Most of these patients (91.8%) were discharged without admission to hospital. Almost all patients who presented to general practice (99%) and urgent care clinics (97.6%) were discharged to home directly. CONCLUSION: The RACPP is safe and effective at excluding MACEs in NZ rural hospital and primary care settings, where it can identify a group of low-risk patients who can be safely discharged home without transfer to hospital.


Assuntos
Hospitais Rurais , Troponina , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência , Humanos , Nova Zelândia/epidemiologia , Alta do Paciente , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Medição de Risco/métodos
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