A-015 ESC hs-cTnT指南对疑似急性冠状动脉综合征的验证：真实世界数据

IF 6.3 2区医学 Q1 MEDICAL LABORATORY TECHNOLOGY

Clinical chemistry Pub Date : 2025-10-02 DOI:10.1093/clinchem/hvaf086.015

C S Lau, L F Yew, S K Phua, T C Aw

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Subjects with an initial hs-cTnT of &lt;5.0/&gt;52 ng/L are immediately ruled-out/in for ACS. For subjects with initial hs-cTnT 5.0-14 ng/L, and a 0/2H delta of &lt;4.0/&gt;10 ng/L are ruled-out/in respectively; all other cases remained in the observation zone. For subjects with initial hs-cTnT &gt;14 to 52 ng/L, a second sample delta &lt;4.0 or 4.0-10 ng/L remains in observation while a delta &gt;10 ng/L is ruled-in for ACS. Results The first hs-cTnT sample ruled out/in 40/355 subjects (4.6/40.9%), with 473 subjects (54.5%) requiring further observation. Only 1 of the 40 subjects ruled out for ACS had elevated 0/2H delta hs-cTnT (suspected early presenter, first and second sample 4.0 and 28 ng/L respectively). In the observation cohort, 147 subjects had an initial hs-cTnT between 5.0-14 ng/L, of which 129 had a delta &lt;4.0 ng/L after a second sample, 9 had a delta of 4.0-10.0 ng/L, and 9 had a delta of &gt;10.0 ng/L. 326 subjects had an initial hs-cTnT of &gt;14-52 ng/L, of which 204 had a delta of &lt;4.0 ng/L, 54 had a delta of 4.0-10.0 ng/L, and 68 had a delta of &gt;10 ng/L. In total, this resulted in an additional 129/77 subjects being ruled-out/in for ACS after the second sample, with only 267 subjects (30.8%) remaining for further observation (see Figure 1), resulting in a total of 169 subjects being ruled out for ACS (4.6% to 19.5%), and a total of 432 subjects being ruled in (40.9% to 49.8%). Conclusion A single cut-off of an initial hs-cTnT of &lt;5.0 ng/L resulted in 1 early presenter being ruled out for ACS (2.5%). Serial sampling is valuable to reduce the cases in the observation zone as well as increasing the number of rule-out/in cases. 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引用次数: 0

摘要

背景：高敏感性心肌肌钙蛋白T （Hs-cTnT）在急性冠脉综合征（ACS）的治疗中仍然是不可或缺的。使用欧洲心脏病学会（ESC） 0/1和0/2小时hs-cTnT算法来排除ACS。在进行系列检测时，在初始hs-cTnT值中度升高的患者中，可减少观察区病例数。我们使用ESC 0/2小时hs-cTnT （Roche）算法描述了我们机构中规则入/出受试者的分布。方法回顾了2023年至2024年间进行hs-cTnT连续检测的受试者（n = 868）的hs-cTnT结果，并根据已建立的ESC Roche hs-cTnT ACS诊断分类指南对其结果进行评估。初始hs-cTnT为&；lt;5.0/>；52 ng/L立即排除ACS。初始hs-cTnT 5.0-14 ng/L， 0/2H δ为4.0/ gt；分别剔除10 ng/L；所有其他病例仍留在观察区内。初始hs-cTnT &；gt；14至52 ng/L，第二个样品δ δ &；lt；4.0或4.0-10 ng/L继续观察，而δ δ &；gt；ACS标准为10ng /L。结果第一次hs-cTnT样本排除40/355例（4.6/40.9%），473例（54.5%）需要进一步观察。在排除ACS的40名受试者中，只有1名患者0/2H δ hs-cTnT升高（疑似早期呈现者，第一和第二样本分别为4.0和28 ng/L）。在观察队列中，147名受试者的初始hs-cTnT在5.0-14 ng/L之间，其中129名受试者在第二次取样后的δ为4.0 ng/L， 9名受试者的δ为4.0-10.0 ng/L， 9名受试者的δ为10.0 ng/L。326名受试者的初始hs-cTnT为&；gt；14 ~ 52 ng/L，其中204例δ值为4.0 ng/L， 54例δ值为4.0 ~ 10.0 ng/L， 68例δ值为&；gt；10 ng / L。总的来说，这导致在第二次样本后又有129/77名受试者被排除/纳入ACS，仅剩下267名受试者（30.8%）进行进一步观察（见图1），总共有169名受试者被排除为ACS(4.6%至19.5%)，总共有432名受试者被排除（40.9%至49.8%）。结论：初始hs-cTnT为5.0 ng/L的单一截止值导致1例早期表现者被排除为ACS（2.5%）。串行采样对于减少观察区内的病例以及增加排除/在病例的数量是有价值的。0/2小时ESC算法在我院的应用效果良好。

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A-015 Verification of the ESC hs-cTnT guidelines for suspected acute coronary syndromes: real world data

Background High-sensitivity cardiac troponin T (Hs-cTnT) remains indispensable in the management of acute coronary syndromes (ACS). The European Society for Cardiology (ESC) 0/1- and 0/2-hour hs-cTnT algorithms are used to rule out ACS. Where serial testing is performed, the number of cases in the observed zone can be reduced in patients with moderately raised initial hs-cTnT values. We describe the distribution of rule-in/out subjects in our institution, using the ESC 0/2-hour hs-cTnT (Roche) algorithm. Methods We reviewed the hs-cTnT results of subjects with serial hs-cTnT testing between 2023 to 2024 (n = 868) and evaluated their results according to established ESC Roche hs-cTnT guidelines for ACS diagnostic categories. Subjects with an initial hs-cTnT of <5.0/>52 ng/L are immediately ruled-out/in for ACS. For subjects with initial hs-cTnT 5.0-14 ng/L, and a 0/2H delta of <4.0/>10 ng/L are ruled-out/in respectively; all other cases remained in the observation zone. For subjects with initial hs-cTnT >14 to 52 ng/L, a second sample delta <4.0 or 4.0-10 ng/L remains in observation while a delta >10 ng/L is ruled-in for ACS. Results The first hs-cTnT sample ruled out/in 40/355 subjects (4.6/40.9%), with 473 subjects (54.5%) requiring further observation. Only 1 of the 40 subjects ruled out for ACS had elevated 0/2H delta hs-cTnT (suspected early presenter, first and second sample 4.0 and 28 ng/L respectively). In the observation cohort, 147 subjects had an initial hs-cTnT between 5.0-14 ng/L, of which 129 had a delta <4.0 ng/L after a second sample, 9 had a delta of 4.0-10.0 ng/L, and 9 had a delta of >10.0 ng/L. 326 subjects had an initial hs-cTnT of >14-52 ng/L, of which 204 had a delta of <4.0 ng/L, 54 had a delta of 4.0-10.0 ng/L, and 68 had a delta of >10 ng/L. In total, this resulted in an additional 129/77 subjects being ruled-out/in for ACS after the second sample, with only 267 subjects (30.8%) remaining for further observation (see Figure 1), resulting in a total of 169 subjects being ruled out for ACS (4.6% to 19.5%), and a total of 432 subjects being ruled in (40.9% to 49.8%). Conclusion A single cut-off of an initial hs-cTnT of <5.0 ng/L resulted in 1 early presenter being ruled out for ACS (2.5%). Serial sampling is valuable to reduce the cases in the observation zone as well as increasing the number of rule-out/in cases. The 0/2-hour ESC algorithm performed well in our hospital.

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来源期刊

Clinical chemistry 医学-医学实验技术

CiteScore

11.30

自引率

4.30%

发文量

212

审稿时长

1.7 months

期刊介绍： Clinical Chemistry is a peer-reviewed scientific journal that is the premier publication for the science and practice of clinical laboratory medicine. It was established in 1955 and is associated with the Association for Diagnostics & Laboratory Medicine (ADLM). The journal focuses on laboratory diagnosis and management of patients, and has expanded to include other clinical laboratory disciplines such as genomics, hematology, microbiology, and toxicology. It also publishes articles relevant to clinical specialties including cardiology, endocrinology, gastroenterology, genetics, immunology, infectious diseases, maternal-fetal medicine, neurology, nutrition, oncology, and pediatrics. In addition to original research, editorials, and reviews, Clinical Chemistry features recurring sections such as clinical case studies, perspectives, podcasts, and Q&A articles. It has the highest impact factor among journals of clinical chemistry, laboratory medicine, pathology, analytical chemistry, transfusion medicine, and clinical microbiology. The journal is indexed in databases such as MEDLINE and Web of Science.