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Master Thesis

Dosage de troponine positive réalisé en ambulatoire : analyse des patients adressés aux urgences et conséquences sur le délai de prise en charge

Abstract : Introduction : Troponin has become the reference biological marker for the diagnosis of Acute Coronary Syndrome (ACS). It is usually dosed within the confounds of hospital emergency care but its prescription has been ever increasing in primary care. The objective of this study was to characterize patients referred by their attending physician to the emergency department for a positive troponin assay performed in ambulatory care and evaluate the delay between dosage and diagnosis and management of the underlying cause. Material and methods : A retrospective, monocentric, observational study, carried out in 2015 in the Felix Guyon University Hospital Hospital Emergency Department (UAS) in Reunion. Results : Three thousand, one hundred and thirty-nine files were consulted to identify the patients consulting due to positive troponin assays in non hospital labs. Eighty-one patients were identified and included in this observational study. The median age of the patients was 70 [60-82]. More than half (56.8%) arrived at the UAS on their own. During the consult, chest pain was reported in 81.5% of patients, 14% of whom were younger than 12h. An electrocardiogram was performed as an outpatient for 26% of patients. Nearly 47% were hospitalized in the Intensive Cardiac Care Unit (ICUU). In total, we identified 14 cases (18%) with late-onset myocardial infarction, 10 with myocardial sequelae on cardiac echocardiography and 4 of them revascularized by coronary artery bypass grafting. Conclusion : Despite clear recommendations published in 2010 concerning the role of troponin in primary care, many dosages are prescribed for outpatients and seems to lead to a delay in management and therefore to a loss of chances for potential coronary patients with a high risk of non or late-revascularization resulting in often irreversible myocardial sequelae. A complementary study to evaluate the reasons for prescribing this dosage in outpatient care as well as the event-rate of patients whose dosage remained negative should be undertaken.
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Master Thesis
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Aude Boleis. Dosage de troponine positive réalisé en ambulatoire : analyse des patients adressés aux urgences et conséquences sur le délai de prise en charge. Sciences du Vivant [q-bio]. 2018. ⟨dumas-01904469⟩

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