Advertisement

Annales françaises de médecine d'urgence

, Volume 6, Issue 4, pp 246–252 | Cite as

Évaluation de l’intérêt du dosage de la troponine hypersensible pour le diagnostic de syndrome coronarien aigu à la phase aiguë d’un accident vasculaire cérébral aux urgences

  • E. MercierEmail author
  • P. Piquet
  • A. Boué
  • E. Larosa
  • Y. M. Yven
  • D. Lauque
  • A. Viguié
  • S. Charpentier
Article Original / Original Article
  • 111 Downloads

Résumé

Introduction

Une étude menée en 2013 dans notre service d’urgences montrait que la troponine était utilisée aux urgences pour rechercher un syndrome coronaire aigu (SCA) dans plus de deux tiers des cas en dehors des douleurs thoraciques. L’objectif de notre étude est d’évaluer l’intérêt du dosage de la troponine hypersensible (TnThs) pour le diagnostic de SCA chez les patients admis aux urgences pour accident vasculaire cérébral (AVC) confirmé. L’objectif secondaire est d’évaluer la valeur pronostique de la TnThs en recherchant si elle peut être un marqueur de la gravité et de l’étiologie de l’AVC.

Matériel et méthode

Il s’agissait d’une étude prospective monocentrique menée aux urgences d’un hôpital universitaire. Tout patient se présentant pour suspicion d’AVC était inclus, avait un dosage de la TnThs et un électrocardiogramme. Le critère de jugement principal était le diagnostic de SCA. Les critères de jugements secondaires étaient la gravité clinique et l’étiologie de l’AVC.

Résultats

De janvier à mai 2014, 220 patients ont été inclus. Le diagnostic final de SCA a été retenu pour quatre patients admis pour AVC (1,82 %; IC95 % [0,4-4,5]). Plus la gravité clinique était élevée, plus le pourcentage de TnThs positive était élevée: 74 % chez les patients dont NIHSS >17 vs 34 % lorsque NIHSS <6 (p<0,001). Parmi les découvertes de fibrillation auriculaire (ACFA), 60 % avaient une TnThs positive vs 28 % chez les patients sans ACFA retrouvée (p<0,001).

Conclusion

Il n’est pas justifié d’utiliser la TnThs de manière systématique aux urgences pour rechercher un SCA chez un patient admis pour AVC. Cependant, son utilisation paraît intéressante pour prédire l’étiologie et la gravité des AVC.

Mots clés

Troponine hypersensible AVC SCA Urgences 

Assessment of the sensitive troponin value for the acute coronary syndrome diagnosis in patients with acute stroke in emergency department

Abstract

Introduction

A study conducted in 2013 in our emergency department showed that troponin was used to rule in acute coronary syndrome (ACS) in the emergency room (ER) in more than two thirds of patients without chest pain. The aim of the study was to determine whether highsensitivity troponin T (hsTnT) testing in the ER is useful for ACS diagnosis among patients admitted for confirmed cerebrovascular accident (CVA). An additional aim was to evaluate hsTnT prognostic value as an etiologic and severity index factor.

Material and methods

This prospective study held in the emergency department of a French university hospital included all patients who were suspected of CVA. hsTnT was measured and an electrocardiogram was performed. The primary outcome was ACS diagnosis. Secondary outcomes included the National Institute of Health Stroke Scale (NIHSS) as clinical severity index and CVA etiology.

Results

From January to May 2014, 220 patients were included. Four were diagnosed ACS (1.82%; IC95% [0.4-4.5]). The higher the NIHSS the more the hsTnT test was positive: 74% with NIHSS>17 vs 34% with NIHSS<6 (p<0.001). Among patients with first diagnosis of atrial fibrillation (AF) 60% had positive hsTnT vs 28% among patients without AF (p<0.001).

Conclusion

Systematic hsTnT testing in ER to diagnose ACS in CVA patients is not justified. However, its use may be interesting as a predictive severity index factor or etiologic biomarker.

Keywords

High-sensitivity troponin T Cerebrovascular accident Acute coronary syndrome Emergency room 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Références

  1. 1.
    Thygesen K, Alpert JS, White HD, et al (2007) Task force for the redefinition of myocardial infarction universal definition of myocardial infarction. Eur Heart J 28:2525–38CrossRefPubMedGoogle Scholar
  2. 2.
    Lefèvre G, Laperche T (2009) Marqueurs biochimiques du syndrome coronarien aigu. Rev Fr Lab 39:51–7Google Scholar
  3. 3.
    Weber S (2013) Intérêts et limites de l’utilisation clinique des biomarqueurs en cardiologie. Rev Fr Lab 43:22–4Google Scholar
  4. 4.
    Wilson SR, Sabatine MS, Braunwald E, et al (2009). Detection of myocardial injury in patients with unstable angina using a novel nanoparticle cardiac troponin I assay: observations from the PROTECT-TIMI 30 Trial. Am Heart J 158:386–91CrossRefPubMedGoogle Scholar
  5. 5.
    Apple FS, Smith SW, Pearce LA, et al (2008) Use of the Centaur TnIUltra assay for detection of myocardial infarction and adverse events in patients presenting with symptoms suggestive of acute coronary syndrome. Clin Chem 54:723–8CrossRefPubMedGoogle Scholar
  6. 6.
    Reichlin T, Hochholzer W, Bassetti S, et al (2009). Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med 361:858–67CrossRefPubMedGoogle Scholar
  7. 7.
    Bonaca M, Scirica B, Sabatine M, et al (2010) Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I. J Am Coll Cardiol 55:2118–24CrossRefPubMedGoogle Scholar
  8. 8.
    Youssef Boukili M (2012) Troponines hypersensibles: vers une nouvelle définition de l’infarctus du myocarde ? Presse Med 41:634–7CrossRefGoogle Scholar
  9. 9.
    Thygesen K, Alpert JS, Jaffe AS, et al (2012) Third universal definition of myocardial infarction. Eur Heart J 33:2551–67CrossRefPubMedGoogle Scholar
  10. 10.
    Rost NS, Bottle A, Lee JM, et al (2016) Stroke Severity Is a Crucial Predictor of Outcome: An International Prospective Validation Study. J Am Heart Assoc 21:5Google Scholar
  11. 11.
    Sato S, Toyoda K, Uehara T, et al (2008) Baseline NIH stroke scale score predicting outcome in anterior and posterior circulation strokes. Neurology 70:2371–7CrossRefPubMedGoogle Scholar
  12. 12.
    Adams HP, Bendixen BH, Kappelle LJ, et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35–41Google Scholar
  13. 13.
    Charpentier S, Lepage B, Maupas-Schwalm F, et al (2013) Copeptin improves the diagnostic performance of sensitive troponin I-Ultra but cannot rapidly rule out non-ST-elevation myocardial infarction at presentation to an emergency department. Ann Emerg Med 61:549–58CrossRefPubMedGoogle Scholar
  14. 14.
    Aldous SJ, Richards MA, Cullen L, et al (2012) A new improved accelerated diagnostic protocol safely identifies low-risk patients with chest pain in the emergency department. Acad Emerg Med Off J Soc Acad Emerg Med 19:510–6CrossRefGoogle Scholar
  15. 15.
    Anders B, Alonso A, Artemis D, et al (2013) What does elevated high-sensitive troponin I in stroke patients mean: concomitant acute myocardial infarction or a marker for high-risk patients? Cerebrovasc Dis 36:211–7CrossRefPubMedGoogle Scholar
  16. 16.
    Kerr G, Ray G, Wu O, et al (2009) Elevated troponin after stroke: a systematic review. Cerebrovasc Dis 28:220–6CrossRefPubMedGoogle Scholar
  17. 17.
    Kral M, Sanak D, Veverka T, et al (2013) Troponin T in acute ischemic stroke. Am J Cardiol 112:117–21CrossRefPubMedGoogle Scholar
  18. 18.
    González Toledo ME, Klein FR, Riccio PM, et al (2013) Atrial fibrillation detected after acute ischemic stroke: evidence supporting the neurogenic hypothesis. Stroke 22:486–91Google Scholar
  19. 19.
    Barber M, Morton JJ, Macfarlane PW, et al (2006) Elevated troponin levels are associated with sympathoadrenal activation in acute ischaemic stroke. Cerebrovasc Dis 23:260–6CrossRefPubMedGoogle Scholar
  20. 20.
    Scheitz JF, Endres M, Mochmann HC, et al (2012) Frequency, determinants and outcome of elevated troponin in acute ischemic stroke patients. Int J Cardiol 157:239–42CrossRefPubMedGoogle Scholar
  21. 21.
    Jensen JK, Atar D, Mickley H (2007) Mechanism of troponin elevations in patients with acute ischemic stroke. Am J Cardiol 99:867–70CrossRefPubMedGoogle Scholar
  22. 22.
    Jensen JK (2007) Frequency and significance of troponin T elevation in acute ischemic stroke. Am J Cardiol 99:108–12CrossRefPubMedGoogle Scholar
  23. 23.
    Angelantonio ED (2005) Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke. J Neurosurg Psychiatry 76:76–81CrossRefGoogle Scholar
  24. 24.
    Beaulieu-Boire I, Leblanc N, Berger L, et al (2013) Troponin elevation predicts atrial fibrillation in patients with stroke or transient ischemic attack. J Stroke Cerebrovascular Dis 22:978–83CrossRefGoogle Scholar

Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2016

Authors and Affiliations

  • E. Mercier
    • 1
    Email author
  • P. Piquet
    • 2
  • A. Boué
    • 1
  • E. Larosa
    • 3
  • Y. M. Yven
    • 4
  • D. Lauque
    • 4
  • A. Viguié
    • 4
  • S. Charpentier
    • 5
    • 6
  1. 1.CHG AUCHAuchFrance
  2. 2.CHIVAFoix cedexFrance
  3. 3.CH Comminges PyrénéesSaint GaudensFrance
  4. 4.CHU PurpanToulouseFrance
  5. 5.CHU RangueilToulouseFrance
  6. 6.INSERM équipe 5ToulouseFrance

Personalised recommendations