1
|
Ali F, Arshad K, Szpunar S, Daher E. Elevated Troponins and Diagnosis of Non-ST-Elevation Myocardial Infarction in the Emergency Department. Cureus 2024; 16:e59910. [PMID: 38854192 PMCID: PMC11161129 DOI: 10.7759/cureus.59910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Background In the emergency department (ED), the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is primarily based on the presence or absence of elevated cardiac troponin levels, ECG changes, and clinical presentation. However, limited data exist regarding the incidence, clinical characteristics, and predictive value of different cardiac diagnostic tests and outcomes in patients with non-acute coronary syndrome (ACS)-related troponin elevation. Our study aimed to determine the percentage of patients with elevated troponin levels who had true ACS and identify various risk factors associated with true ACS in these patients. Methodology This was a single-center retrospective study. We performed a chart review of patients who presented to the ED from January 1, 2016, to December 31, 2017, and were admitted to the hospital with an elevated cardiac troponin I level in the first 12 hours after ED presentation with a diagnosis of NSTEMI. True ACS was defined as (a) patients with typical symptoms of ischemia and ECG ischemic changes and (b) patients with atypical symptoms of myocardial ischemia or without symptoms of ischemia and new segmental wall motion abnormalities on echocardiogram or evidence of culprit lesion on angiography. A logistic regression model was used to determine the association between risk factors and true ACS. Results A total of 204 patients were included in this study. The mean age of the study group was 67.4 ± 14.5 years; 53.4% (n = 109) were male, and 57.4% (n = 117) were Caucasian. In our study, 51% of patients were found to have true ACS, and the remaining 49% had a non-ACS-related elevation in troponins. Most patients without ACS had alternate explanations for elevated troponin levels. The presence of chest pain (odds ratio (OR) = 3.7, 95% confidence interval (CI) = 1.8-7.7, p = 0.001), tobacco smoking (OR = 4, 95% CI = 1.06-3.8, p = 0.032), and wall motion abnormalities on echocardiogram (OR = 3.8, 95% CI = 1.8-6.5, p = 001) were associated with increased risk of true ACS in patients with elevated troponins. Conclusions Cardiac troponin levels can be elevated in hospitalized patients with various medical conditions, in the absence of ACS. The diagnosis of ACS should not be solely based on elevated troponin levels, as it can lead to expensive workup and utilization of hospital resources.
Collapse
Affiliation(s)
- Farman Ali
- Medicine, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Khurram Arshad
- Internal Medicine, Corewell Health East Dearborn, Dearborn, USA
| | - Susan Szpunar
- Biomedical Investigations and Research, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Edouard Daher
- Cardiology, Ascension St. John Hospital and Medical Center, Detroit, USA
| |
Collapse
|
2
|
Huang PY, Shih HM, Huang SW, Pan YC, Huang FW, Chen WK, Yu SH. Comparison of In-Hospital Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Treated with Ticagrelor or Clopidogrel in the Emergency Department: A Propensity Score Matched Retrospective Cohort Study. Healthcare (Basel) 2023; 11:2246. [PMID: 37628444 PMCID: PMC10454921 DOI: 10.3390/healthcare11162246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/28/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Dual antiplatelet therapy (DAPT) is a standard treatment option for acute myocardial infarction (AMI). The difference between the efficacy of ticagrelor and clopidogrel in the emergency department (ED) before percutaneous coronary intervention (PCI) remains unknown. The present study compared the in-hospital major adverse cardiovascular event (MACE) rates between patients with AMI treated with clopidogrel and those treated with ticagrelor in the ED before PCI. METHODS We retrospectively collected the data of patients diagnosed as having AMI in the ED. Patients were only included if they had successfully received complete DAPT with aspirin and ticagrelor/clopidogrel in the ED and had undergone PCI. The patients were divided into two groups according to their DAPT regimen. The primary outcome was the rate of in-hospital MACEs. The secondary outcomes included an unexpected return to the ED within 72 h, readmission within 14 d, and revascularization. RESULTS A total of 1836 patients were enrolled. Patients in the ticagrelor group had a lower in-hospital MACE rate (3.01% versus 7.51%, p < 0.001) and in-hospital mortality rate (2.15% versus 5.70%, p < 0.001) than those in the clopidogrel group. Multivariate logistic regression analysis revealed ticagrelor was independently associated with a lower risk of in-hospital MACEs (odds ratio [OR]: 0.53, 95% CI: 0.32-0.88, p = 0.013). After propensity score matching, the risk of in-hospital MACEs remained significantly lower in the ticagrelor group (OR 0.42, 95% CI: 0.21-0.85, p = 0.016). CONCLUSION DAPT with ticagrelor and aspirin in the ED before PCI is associated with a lower in-hospital MACE rate among patients with AMI.
Collapse
Affiliation(s)
- Po-Yao Huang
- Department of Emergency Medicine, China Medical University Hospital, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Hong-Mo Shih
- Department of Emergency Medicine, China Medical University Hospital, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
- Department of Public Health, China Medical University, Taichung 40402, Taiwan
| | - Szu-Wei Huang
- Department of Emergency Medicine, China Medical University Hospital, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Yan-Cheng Pan
- Department of Emergency Medicine, China Medical University Hospital, Taichung 40402, Taiwan
| | - Fen-Wei Huang
- Department of Emergency Medicine, China Medical University Hospital, Taichung 40402, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Shao-Hua Yu
- Department of Emergency Medicine, China Medical University Hospital, Taichung 40402, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
| |
Collapse
|
3
|
Chu CH, Shih HM, Yu SH, Chang SS, Sie JS, Huang FW, Hsu TY. Risk factors for sudden cardiac arrest in patients with ST-segment elevation myocardial infarction: a retrospective cohort study. BMC Emerg Med 2022; 22:169. [PMID: 36280807 PMCID: PMC9590157 DOI: 10.1186/s12873-022-00732-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sudden cardiac arrest (SCA) is a critical complication of acute myocardial infarction, especially ST-segment elevation myocardial infarction (STEMI). This study identified the risk factors for SCA in patients with STEMI before receiving catheterization. Methods We retrospectively analyzed the data of patients with STEMI and cardiac arrest who presented to a tertiary care center in Taiwan between January 1, 2016, and December 31, 2019. Only patients with coronary artery disease (CAD) confirmed by coronary angiography were included in this study. We collected the patients’ demographic and clinical data, such as age, sex, medical history, estimated glomerular filtration rate (eGFR), and coronary angiographic findings. The primary outcome of this study was SCA in patients with STEMI. Continuous and nominal variables were compared using the two-sample Student's t-test and chi-squared test, respectively. The results of logistic regression were subjected to multivariate analysis with adjustment for possible confounders. Results A total of 920 patients with STEMI and coronary angiography–documented CAD and 108 patients with SCA who presented between January 1, 2016, and December 31, 2019, were included. The bivariate logistic regression analysis of patients’ demographic data revealed that patients with STEMI and SCA were slightly younger, were more likely to have diabetes mellitus, and had a lower eGFR than did the patients without SCA. The coronary angiographic findings indicated a higher prevalence of left main CAD and three-vessel disease in patients with SCA than in patients without SCA. Multivariate logistic regression revealed that left main CAD (odds ratio [OR]: 3.77; 95% confidence interval [CI], 1.84 to 7.72), a lower eGFR (OR: 0.97; 95% CI, 0.96 to 0.98), and younger age (OR: 0.98; 95% CI, 0.96 to 0.99) were the risk factors for SCA in patients with STEMI. Conclusions Left main CAD, lower eGFR, and younger age are the risk factors for cardiac arrest in patients with acute myocardial infarction.
Collapse
Affiliation(s)
- Chang-Hung Chu
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Hong-Mo Shih
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Department of Public Health, China Medical University, No.100, Section 1, Economic and Trade Rd., Taichung, 406 Taiwan
| | - Shao-Hua Yu
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Graduate Institute of Biomedical Sciences, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan
| | - Shih-Sheng Chang
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Division of Cardiovascular Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Ji-Syuan Sie
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Fen-Wei Huang
- grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan
| | - Tai-Yi Hsu
- grid.254145.30000 0001 0083 6092School of Medicine, College of Medicine, China Medical University, No. 91, Xueshi Rd., Taichung, 404 Taiwan ,grid.411508.90000 0004 0572 9415Department of Emergency Medicine, China Medical University Hospital, No. 2, Yude Rd., Taichung, 404 Taiwan ,grid.254145.30000 0001 0083 6092Department of Public Health, China Medical University, No.100, Section 1, Economic and Trade Rd., Taichung, 406 Taiwan
| |
Collapse
|