Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry

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• 作者：Alexander Illmann (1)
  Thomas Riemer (2)
  Raimund Erbel (3)
  Evangelos Giannitsis (4)
  Christian Hamm (5)
  Michael Haude (6)
  Gerd Heusch (7)
  Lars S. Maier (8)
  Thomas Münzel (9)
  Claus Schmitt (10)
  Burghard Schumacher (11)
  Jochen Senges (2)
  Thomas Voigtl?nder (12)
  Harald Mudra (1)
  
• 关键词：Chest pain unit ; Troponin ; Acute coronary syndrome ; Non ; coronary ; Revascularization ; Outcome
• 刊名：Clinical Research in Cardiology
• 出版年：2014
• 出版时间：January 2014
• 年：2014
• 卷：103
• 期：1
• 页码：29-40
• 全文大小：297 KB
• 作者单位：Alexander Illmann (1)
  Thomas Riemer (2)
  Raimund Erbel (3)
  Evangelos Giannitsis (4)
  Christian Hamm (5)
  Michael Haude (6)
  Gerd Heusch (7)
  Lars S. Maier (8)
  Thomas Münzel (9)
  Claus Schmitt (10)
  Burghard Schumacher (11)
  Jochen Senges (2)
  Thomas Voigtl?nder (12)
  Harald Mudra (1)
  
  1. Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, St?dtisches Klinikum München GmbH, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany
  2. Institut für Herzinfarktforschung an der Universit?t Heidelberg, Ludwigshafen, Germany
  3. West German Heart Center Essen, University Duisburg-Essen, Essen, Germany
  4. 3rd Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany
  5. Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany
  6. 1st Department of Medicine, St?dtische Kliniken Neuss, Lukaskrankenhaus, Neuss, Germany
  7. Institute for Pathophysiology, University Duisburg-Essen, Essen, Germany
  8. Department of Cardiology and Pneumology, Georg-August-University G?ttingen, G?ttingen, Germany
  9. 2nd Department of Medicine, Johannes Gutenberg-University Mainz, Mainz, Germany
  10. Clinic for Cardiology and Angiology, St?dtisches Klinikum Karlsruhe, Karlsruhe, Germany
  11. 2nd Department of Medicine, Westpfalz-Klinikum, Kaiserslautern, Germany
  12. CCB, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
  
• ISSN：1861-0692

文摘

Objectives The aim of this analysis was to compare troponin-positive patients presenting to a chest pain unit (CPU) and undergoing coronary angiography with or without subsequent revascularization. Leading diagnosis, disease distribution, and short-term outcomes were evaluated. Background Chest pain units are increasingly implemented to promptly clarify acute chest pain of uncertain origin, including patients with suspected acute coronary syndrome (ACS). Methods A total of 11,753 patients were prospectively enrolled into the German CPU-Registry of the German Cardiac Society between December 2008 and April 2011. All patients with elevated troponin undergoing a coronary angiography were selected. Three months after discharge a follow-up was performed. Results A total of 2,218 patients were included. 1,613 troponin-positive patients (72.7?%) underwent a coronary angiography with subsequent PCI or CABG and had an ACS in 96.0?%. In contrast, 605 patients (27.3?%) underwent a coronary angiography without revascularization and had an ACS in 79.8?%. The most frequent non-coronary diagnoses in non-revascularized patients were acute arrhythmias (13.4?%), pericarditis/myocarditis (4.5?%), decompensated congestive heart failure (3.7?%), Takotsubo cardiomyopathy (2.7?%), hypertensive crisis (2.4?%), and pulmonary embolism (0.3?%). During the 3-month follow-up, patients without revascularization had a higher mortality (12.1 vs. 4.5?%, p?<?0.0001) representing the major contributor to the higher rate of MACCE (15.1 vs. 8.1?%, p?<?0.001). These data were confirmed in a subgroup analysis of ACS patients with or without revascularization. Conclusions Patients presenting to a CPU with elevated troponin levels mostly suffer from ACS and in a smaller proportion a variety of different diseases are responsible. The short-term outcome in troponin-positive patients with or without an ACS not undergoing a revascularization was worse, indicating that these patients were more seriously ill than patients with revascularization of the culprit lesion. Therefore, an adequate diagnostic evaluation and improved treatment strategies are warranted.