Investigations for the assessment of adult patients presenting to the emergency department with supraventricular tachycardia

The Role of Troponin Testing in Patients with Supraventricular Tachycardia, Systematic Review and Meta-Analysis

BACKGROUND

Supraventricular tachycardia (SVT) is commonly evaluated in the emergency department (ED). While troponin has been shown to be elevated in SVT, its usefulness for predicting coronary artery disease and future adverse cardiovascular outcomes has not been shown.

OBJECTIVES

We aimed to evaluate the prognostic utility of troponin measurement as part of SVT management in the ED.

METHODS

We performed a literature search in the PubMed and Scopus databases from inception to August 30, 2023, including all studies reporting troponin measurements in adult patients (age > 18 years) presenting to the ED with supraventricular tachycardia. The primary outcome of interest for this study was the prevalence of elevated troponin in patients with SVT. Secondary outcomes included the prevalence of major adverse cardiac events (MACE) and additional cardiac testing with significant findings.

RESULTS

We included 7 studies (500 patients) in our analysis. Six studies reported the number of patients with SVT and elevated troponin, with a pooled prevalence of 46% (95% CI 27-66%, I2 93%). The pooled prevalence of all MACE in our study was 6% (95% CI 1-25%), while the prevalence for MACE among patients with elevated serum troponin levels was 11% (95% CI 4-27%).

CONCLUSIONS

Troponin levels are frequently ordered for ED patients with SVT and are often elevated. However, this review suggests that they have low prognostic value in predicting MACE.

Eff ects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome

BACKGROUND

We aim to investigate effects of metabolic syndrome on onset age and long-term outcomes in patients with acute coronary syndrome (ACS).

METHODS

Patients with ACS (n=6,431) who underwent percutaneous coronary intervention from January to December 2013 were enrolled. After excluding patients with previous coronary artery disease, 1,558 patients were diagnosed with early-onset ACS (men aged ≤50 years; women aged ≤60 years) and 3,044 patients with late-onset ACS. Baseline characteristics and five-year clinical outcomes were measured.

RESULTS

Body mass index, triglyceride, low-density lipoprotein cholesterol, and uric acid concentrations were significantly higher, while the high-density lipoprotein cholesterol (HDL-C) concentration was lower in the early-onset ACS group (P<0.001). Multivariate logistic regression revealed obesity (odds ratio [OR] 1.590, 95% confidence interval [CI] 1.345-1.881), hypertriglyceridemia (OR 1.403, 95% CI 1.185-1.660), and low HDL-C (OR 1.464, 95% CI 1.231-1.742) as independent risk factors for early-onset ACS (all P<0.001). The five-year follow-up showed that the incidences of all cause death (1.5% vs. 3.8%, P<0.001), cardiac death (1.1% vs. 2.0%, P=0.023), and recurrent stroke (2.2% vs. 4.2%, P<0.001) were lower, while bleeding events were more frequent in the early-onset ACS group. A subgroup analysis showed higher incidences of recurrent myocardial infarction (MI) and revascularization in patients with early-onset ACS and metabolic syndrome.

CONCLUSIONS

Obesity, hypertriglyceridemia, and lower HDL-C level are independent risk factors for early-onset ACS, recurrent MI, and revascularization. The control of metabolic syndrome may reduce the incidence of early-onset ACS and improve the long-term prognosis.