PDF(Pubmed)
Abstract：
UNASSIGNED: Guidelines recommend high-sensitivity cardiac troponin to risk stratify patients with possible myocardial infarction and identify those eligible for discharge. Our aim was to evaluate adoption of this approach in practice and to determine whether effectiveness and safety varies by age, sex, ethnicity, or socioeconomic deprivation status.
UNASSIGNED: A multi-centre cohort study was conducted in 13 hospitals across the United Kingdom from November 1st, 2021, to October 31st, 2022. Routinely collected data including high-sensitivity cardiac troponin I or T measurements were linked to outcomes. The primary effectiveness and safety outcomes were the proportion discharged from the Emergency Department, and the proportion dead or with a subsequent myocardial infarction at 30 days, respectively. Patients were stratified using peak troponin concentration as low (<5 ng/L), intermediate (5 ng/L to sex-specific 99th percentile), or high-risk (>sex-specific 99th percentile).
UNASSIGNED: In total 137,881 patients (49% [67,709/137,881] female) were included of whom 60,707 (44%), 42,727 (31%), and 34,447 (25%) were stratified as low-, intermediate- and high-risk, respectively. Overall, 65.8% (39,918/60,707) of low-risk patients were discharged from the Emergency Department, but this varied from 26.8% [2200/8216] to 93.5% [918/982] by site. The safety outcome occurred in 0.5% (277/60,707) and 11.4% (3917/34,447) of patients classified as low- or high-risk, of whom 0.03% (18/60,707) and 1% (304/34,447) had a subsequent myocardial infarction at 30 days, respectively. A similar proportion of male and female patients were discharged (52% [36,838/70,759] versus 54% [36,113/67,109]), but discharge was more likely if patients were <70 years old (61% [58,533/95,227] versus 34% [14,428/42,654]), from areas of low socioeconomic deprivation (48% [6697/14,087] versus 43% [12,090/28,116]) or were black or asian compared to caucasian (62% [5458/8877] and 55% [10,026/18,231] versus 46% [35,138/75,820]).
UNASSIGNED: Despite high-sensitivity cardiac troponin correctly identifying half of all patients with possible myocardial infarction as being at low risk, only two-thirds of these patients were discharged. Substantial variation in the discharge of patients by age, ethnicity, socioeconomic deprivation, and site was observed identifying important opportunities to improve care.
UNASSIGNED: UK Research and Innovation.
UNASSIGNED: A multi-centre cohort study was conducted in 13 hospitals across the United Kingdom from November 1st, 2021, to October 31st, 2022. Routinely collected data including high-sensitivity cardiac troponin I or T measurements were linked to outcomes. The primary effectiveness and safety outcomes were the proportion discharged from the Emergency Department, and the proportion dead or with a subsequent myocardial infarction at 30 days, respectively. Patients were stratified using peak troponin concentration as low (<5 ng/L), intermediate (5 ng/L to sex-specific 99th percentile), or high-risk (>sex-specific 99th percentile).
UNASSIGNED: In total 137,881 patients (49% [67,709/137,881] female) were included of whom 60,707 (44%), 42,727 (31%), and 34,447 (25%) were stratified as low-, intermediate- and high-risk, respectively. Overall, 65.8% (39,918/60,707) of low-risk patients were discharged from the Emergency Department, but this varied from 26.8% [2200/8216] to 93.5% [918/982] by site. The safety outcome occurred in 0.5% (277/60,707) and 11.4% (3917/34,447) of patients classified as low- or high-risk, of whom 0.03% (18/60,707) and 1% (304/34,447) had a subsequent myocardial infarction at 30 days, respectively. A similar proportion of male and female patients were discharged (52% [36,838/70,759] versus 54% [36,113/67,109]), but discharge was more likely if patients were <70 years old (61% [58,533/95,227] versus 34% [14,428/42,654]), from areas of low socioeconomic deprivation (48% [6697/14,087] versus 43% [12,090/28,116]) or were black or asian compared to caucasian (62% [5458/8877] and 55% [10,026/18,231] versus 46% [35,138/75,820]).
UNASSIGNED: Despite high-sensitivity cardiac troponin correctly identifying half of all patients with possible myocardial infarction as being at low risk, only two-thirds of these patients were discharged. Substantial variation in the discharge of patients by age, ethnicity, socioeconomic deprivation, and site was observed identifying important opportunities to improve care.
UNASSIGNED: UK Research and Innovation.
摘要：
■指南建议使用高敏心肌肌钙蛋白对可能有心肌梗死的患者进行风险分层，并确定那些符合出院条件的患者。我们的目的是评估在实践中采用这种方法，并确定有效性和安全性是否因年龄而异。性别,种族,或社会经济剥夺地位。
■一项多中心队列研究从11月1日起在英国13家医院进行，2021年，至10月31日，2022年。常规收集的数据，包括高敏心肌肌钙蛋白I或T测量值与结果相关。主要有效性和安全性结果是急诊科出院的比例，以及30天死亡或随后发生心肌梗塞的比例，分别。患者使用峰值肌钙蛋白浓度分层为低（<5ng/L），中级(5ng/L至性别特异性第99百分位数)，或高风险（>性别特异性第99百分位数）。
■总共137,881名患者（49％[67,709/137,881]为女性），其中60,707名（44％），42,727（31%），和34,447（25％）被分层为低，中高风险，分别。总的来说,65.8%(39,918/60,707)的低危病人从急诊科出院,但从26.8%[2200/8216]到93.5%[918/982]。安全性结果发生在0.5%(277/60,707)和11.4%(3917/34,447)的低风险或高风险患者中。其中0.03％（18/60,707）和1％（304/34,447）在30天随后发生心肌梗塞，分别。男性和女性患者的出院比例相似（52％[36,838/70,759]与54％[36,113/67,109]），但如果患者年龄<70岁，则更有可能出院（61%[58,533/95,227]对34%[14,428/42,654]），来自社会经济匮乏程度较低的地区（48％[6697/14,087]对43％[12,090/28,116]）或黑人或亚洲人与高加索人相比（62％[5458/8877]和55％[10,026/18,231]对46％[35,138/75,820]）。
■尽管高敏肌钙蛋白能正确识别出一半可能有心肌梗死的患者处于低风险，这些患者中只有三分之二出院。患者出院的年龄差异很大，种族,社会经济剥夺，并观察到现场发现了改善护理的重要机会。
■英国研究与创新。
■一项多中心队列研究从11月1日起在英国13家医院进行，2021年，至10月31日，2022年。常规收集的数据，包括高敏心肌肌钙蛋白I或T测量值与结果相关。主要有效性和安全性结果是急诊科出院的比例，以及30天死亡或随后发生心肌梗塞的比例，分别。患者使用峰值肌钙蛋白浓度分层为低（<5ng/L），中级(5ng/L至性别特异性第99百分位数)，或高风险（>性别特异性第99百分位数）。
■总共137,881名患者（49％[67,709/137,881]为女性），其中60,707名（44％），42,727（31%），和34,447（25％）被分层为低，中高风险，分别。总的来说,65.8%(39,918/60,707)的低危病人从急诊科出院,但从26.8%[2200/8216]到93.5%[918/982]。安全性结果发生在0.5%(277/60,707)和11.4%(3917/34,447)的低风险或高风险患者中。其中0.03％（18/60,707）和1％（304/34,447）在30天随后发生心肌梗塞，分别。男性和女性患者的出院比例相似（52％[36,838/70,759]与54％[36,113/67,109]），但如果患者年龄<70岁，则更有可能出院（61%[58,533/95,227]对34%[14,428/42,654]），来自社会经济匮乏程度较低的地区（48％[6697/14,087]对43％[12,090/28,116]）或黑人或亚洲人与高加索人相比（62％[5458/8877]和55％[10,026/18,231]对46％[35,138/75,820]）。
■尽管高敏肌钙蛋白能正确识别出一半可能有心肌梗死的患者处于低风险，这些患者中只有三分之二出院。患者出院的年龄差异很大，种族,社会经济剥夺，并观察到现场发现了改善护理的重要机会。
■英国研究与创新。
