{"id":25068,"date":"2024-01-16T04:54:00","date_gmt":"2024-01-15T20:54:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25068"},"modified":"2024-01-16T05:50:43","modified_gmt":"2024-01-15T21:50:43","slug":"bmj%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%ae%9e%e6%96%bd%e9%ab%98%e6%95%8f%e5%bf%83%e8%84%8f%e8%82%8c%e9%92%99%e8%9b%8b%e7%99%bdi%e6%a3%80%e6%b5%8b%e4%b8%8e5%e5%b9%b4%e5%86%85%e5%bf%83","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25068","title":{"rendered":"[BMJ\u53d1\u8868\u8bba\u6587]\uff1a\u5b9e\u65bd\u9ad8\u654f\u5fc3\u810f\u808c\u9499\u86cb\u767dI\u68c0\u6d4b\u4e0e5\u5e74\u5185\u5fc3\u808c\u6897\u6b7b\u6216\u6b7b\u4ea1\u98ce\u9669"},"content":{"rendered":"\n

Research<\/strong><\/p>\n\n\n\n

Implementation of a high sensitivity cardiac troponin I assay and risk of myocardial infarction or death at five years: observational analysis of a stepped wedge, cluster randomised controlled trial<\/h1>\n\n\n\n

Kuan Ken Lee, Dimitrios Doudesis, Amy V Ferry,\u00a0et al<\/h3>\n\n\n\n

BMJ<\/em>\u00a02023;\u00a0383\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj-2023-075009<\/a>\u00a0(Published 28 November 2023)Cite this as:\u00a0BMJ<\/em>\u00a02023;383:e075009<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Objective<\/strong> To evaluate the impact of implementing a high sensitivity assay for cardiac troponin I on long term outcomes in patients with suspected acute coronary syndrome.<\/p>\n\n\n\n

Design<\/strong> Secondary observational analysis of a stepped wedge, cluster randomised controlled trial.<\/p>\n\n\n\n

Setting<\/strong> 10 secondary and tertiary care centres in Scotland, UK.<\/p>\n\n\n\n

Participants<\/strong> 48\u2009282 consecutive patients with suspected acute coronary syndrome. Myocardial injury was defined as any high sensitivity assay result for cardiac troponin I >99th centile of 16 ng\/L in women and 34 ng\/L in men.<\/p>\n\n\n\n

Intervention<\/strong> Hospital sites were randomly allocated to either early (n=5 hospitals) or late (n=5 hospitals) implementation of a high sensitivity cardiac troponin I assay with sex specific diagnostic thresholds.<\/p>\n\n\n\n

Main outcome measure<\/strong> The main outcome was myocardial infarction or death at five years.<\/p>\n\n\n\n

Results<\/strong>\u00a010\u2009360 patients had cardiac troponin concentrations greater than the 99th centile, of whom 1771 (17.1%) were reclassified by the high sensitivity assay. The five year incidence of subsequent myocardial infarction or death before and after implementation of the high sensitivity assay was 29.4% (5588\/18\u2009978)\u00a0v<\/em>25.9% (7591\/29\u2009304), respectively, in all patients (adjusted hazard ratio 0.97, 95% confidence interval 0.93 to 1.01), and 63.0% (456\/720)\u00a0v<\/em>\u00a053.9% (567\/1051), respectively, in those reclassified by the high sensitivity assay (0.82, 0.72 to 0.94). After implementation of the high sensitivity assay, a reduction in subsequent myocardial infarction or death was observed in patients with non-ischaemic myocardial injury (0.83, 0.75 to 0.91) but not in those with type 1 or type 2 myocardial infarction (0.92, 0.83 to 1.01 and 0.98, 0.84 to 1.14).<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions<\/strong> Implementation of a high sensitivity cardiac troponin I assay in the assessment of patients with suspected acute coronary syndrome was associated with a reduced risk of subsequent myocardial infarction or death at five years in those reclassified by the high sensitivity assay. Improvements in outcome were greatest in patients with non-ischaemic myocardial injury, suggesting a broader benefit beyond the identification of myocardial infarction.<\/p>\n\n\n\n

Trial registration<\/strong> ClinicalTrials.gov NCT01852123<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Research Implementation of a high sensitivity cardiac t […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25068"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25068"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25068\/revisions"}],"predecessor-version":[{"id":25069,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25068\/revisions\/25069"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25068"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25068"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25068"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}