Document Detail

Disease distribution and outcome in troponin-positive patients with or without revascularization in a chest pain unit: results of the German CPU-Registry.
MedLine Citation:
PMID:  24077679     Owner:  NLM     Status:  Publisher    
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.
Alexander Illmann; Thomas Riemer; Raimund Erbel; Evangelos Giannitsis; Christian Hamm; Michael Haude; Gerd Heusch; Lars S Maier; Thomas Münzel; Claus Schmitt; Burghard Schumacher; Jochen Senges; Thomas Voigtländer; Harald Mudra
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-9-29
Journal Detail:
Title:  Clinical research in cardiology : official journal of the German Cardiac Society     Volume:  -     ISSN:  1861-0692     ISO Abbreviation:  Clin Res Cardiol     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-9-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264123     Medline TA:  Clin Res Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Cardiology, Pneumology and Internal Intensive Care Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Oskar-Maria-Graf-Ring 51, 81737, Munich, Germany.
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