PMID- 31111144 OWN - NLM STAT- MEDLINE DCOM- 20210421 LR - 20210421 IS - 2058-1742 (Electronic) IS - 2058-1742 (Linking) VI - 6 IP - 1 DP - 2020 Jan 1 TI - Type-II myocardial infarction and chronic myocardial injury rates, invasive management, and 4-year mortality among consecutive patients undergoing high-sensitivity troponin T testing in the emergency department. PG - 41-48 LID - 10.1093/ehjqcco/qcz019 [doi] AB - AIMS: As assessment of patients with suspected acute coronary syndromes (ACS) in emergency departments (EDs) represents a major workload because high-sensitivity troponin (HsTn) T and I levels are frequently measured, and a minority of patients have final diagnosis of myocardial infarction (MI). We determined the relative frequencies of three patients groups: Type-I MI, Type-II MI (including acute myocardial injury). METHODS AND RESULTS: Among 2738 consecutive patients with suspected ACS presenting to ED at Liverpool Hospital, Australia, between March and June 2014. We studied the use of invasive and pharmacological therapies, and 4-year outcomes. Adjudication of MI was according to the 4th universal definition as follows: (i) Type-I MI; (ii) Type-II MI (including acute myocardial injury), and (iii) chronic myocardial injury. Of 995 patients (36%) [median age 76 years (interquartile range 65-83)] with >/=2 HsTnT measurements and one >14 ng/L, 727 (73%) had chronic myocardial injury, 171 (17%) had Type-II MI, and 97 (9.7%) had Type-I MI; respective late mortality rates to 48 months were 33%, 43%, and 14% (P < 0.001). In-hospital angiography rates were 95% for patients with Type-I MI, [62% had percutaneous coronary intervention (PCI)] 24% (7% PCI) for those with Type-II MI, and 3.4% for chronic myocardial injury. On Cox modelling for mortality relative to Type 1 MI, adjusted hazard ratios were 1.94 [95% confidence intervals (CIs) 1.06-3.57]; P = 0.032 for Type 2 MI, and for chronic myocardial injury 1.14 (95% CIs 0.64-2.02); P = 0.66. CONCLUSION: Among unselected patients undergoing HsTnT testing in EDs, Type-II MI including acute myocardial injury was more common than Type-I MI. Chronic myocardial injury, which occurred in three of four patients. Whereas patients with Type-II MI had higher late mortality than those with Type-I MI, after multivariable analyses mortality rates were marginally different. CI - Published on behalf of the European Society of Cardiology. All rights reserved. (c) The Author(s) 2019. For permissions, please email: journals.permissions@oup.com. FAU - Etaher, Aisha AU - Etaher A AD - Department of Cardiology, Liverpool Hospital, Sydney, Elizabeth Street, Locked Bag 7103T, Liverpool BC, New South Wales 1871, Australia. AD - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. FAU - Gibbs, Oliver J AU - Gibbs OJ AD - Department of Cardiology, Liverpool Hospital, Sydney, Elizabeth Street, Locked Bag 7103T, Liverpool BC, New South Wales 1871, Australia. AD - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. FAU - Saad, Yousef M AU - Saad YM AD - Department of Cardiology, Liverpool Hospital, Sydney, Elizabeth Street, Locked Bag 7103T, Liverpool BC, New South Wales 1871, Australia. AD - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. FAU - Frost, Steven AU - Frost S AD - Faculty of Nursing, Western Sydney University, Sydney, New South Wales, Australia. AD - Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia. FAU - Nguyen, Tuan L AU - Nguyen TL AD - Department of Cardiology, Liverpool Hospital, Sydney, Elizabeth Street, Locked Bag 7103T, Liverpool BC, New South Wales 1871, Australia. AD - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. FAU - Ferguson, Ian AU - Ferguson I AD - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. AD - Department of Emergency Medicine, Liverpool Hospital, Sydney, New South Wales, Australia. FAU - Juergens, Craig P AU - Juergens CP AD - Department of Cardiology, Liverpool Hospital, Sydney, Elizabeth Street, Locked Bag 7103T, Liverpool BC, New South Wales 1871, Australia. AD - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. FAU - Chew, Derek AU - Chew D AD - College of Medicine and Public Health, Flinders University of South Australia, Adelaide, South Australia, Australia. FAU - French, John K AU - French JK AD - Department of Cardiology, Liverpool Hospital, Sydney, Elizabeth Street, Locked Bag 7103T, Liverpool BC, New South Wales 1871, Australia. AD - Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia. AD - Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia. LA - eng PT - Journal Article PL - England TA - Eur Heart J Qual Care Clin Outcomes JT - European heart journal. Quality of care & clinical outcomes JID - 101677796 RN - 0 (Troponin T) SB - IM CIN - Eur Heart J Qual Care Clin Outcomes. 2020 Jan 1;6(1):3-4. PMID: 31263882 MH - Acute Coronary Syndrome/*diagnosis/mortality/surgery MH - Aged MH - Aged, 80 and over MH - Coronary Angiography MH - *Emergency Service, Hospital MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/*diagnosis/mortality/surgery MH - *Percutaneous Coronary Intervention MH - Retrospective Studies MH - Risk Factors MH - South Australia/epidemiology MH - Survival Rate/trends MH - Time Factors MH - Troponin T/*blood OTO - NOTNLM OT - Chronic myocardial injury OT - HsTnT OT - Type-I MI OT - Type-II MI OT - mortality EDAT- 2019/05/22 06:00 MHDA- 2021/04/22 06:00 CRDT- 2019/05/22 06:00 PHST- 2019/01/25 00:00 [received] PHST- 2019/03/22 00:00 [revised] PHST- 2019/04/16 00:00 [accepted] PHST- 2019/05/22 06:00 [pubmed] PHST- 2021/04/22 06:00 [medline] PHST- 2019/05/22 06:00 [entrez] AID - 5480169 [pii] AID - 10.1093/ehjqcco/qcz019 [doi] PST - ppublish SO - Eur Heart J Qual Care Clin Outcomes. 2020 Jan 1;6(1):41-48. doi: 10.1093/ehjqcco/qcz019.