Sensitive troponin assay and the classification of myocardial infarction.
Sensitive troponin assay and the classification of myocardial infarction.
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DOI：
10.1016/j.amjmed.2014.10.056
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发表时间：
2015-05
影响因子：
5.9
通讯作者：
Mills, Nicholas L.
中科院分区：
文献类型：
--
作者：
Shah, Anoop S. V.;McAllister, David A.;Mills, Rosamund;Lee, Kuan Ken;Churchhouse, Antonia M. D.;Fleming, Kathryn M.;Layden, Elizabeth;Anand, Atul;Fersia, Omar;Joshi, Nikhil V.;Walker, Simon;Jaffe, Allan S.;Fox, Keith A. A.;Newby, David E.;Mills, Nicholas L.
降低肌钙蛋白的诊断阈值是有争议的，因为它可能不成比例地增加无急性冠脉综合征患者心肌梗死的诊断。我们评估了降低肌钙蛋白的诊断阈值对2型心肌梗死或心肌损伤患者的发病率、治疗和预后的影响。连续出现血浆肌钙蛋白I浓度升高（≥50 ng/L, n = 2929）的患者，在用灵敏测定法将诊断阈值从200降至50 ng/L前后，分别分为1型（50%）心肌梗死、2型心肌梗死或心肌损伤（48%）和3 ~ 5型心肌梗死（2%）。1年时记录死亡和复发性心肌梗死的无事件生存率。降低阈值使2型心肌梗死或心肌损伤的诊断率高于1型心肌梗死（672例vs 257例，P < 0.001）。心肌损伤或2型心肌梗死患者的死亡风险高于1型心肌梗死患者（37% vs 16%；相对危险度[RR]， 2.31； 95%可信区间[CI]， 1.98-2.69），但心肌梗死复发较少（4% vs 12%； RR, 0.35; 95% CI, 0.26-0.49）。在肌钙蛋白浓度为50 ~ 199 ng/L的患者中，降低诊断阈值与增加医疗资源使用相关（P < 0.05），可减少1型心肌梗死患者的复发性心肌梗死和死亡（31% vs 20%； RR, 0.64; 95% CI, 0.41-0.99），但与2型心肌梗死或心肌损伤无关（36% vs 33%； RR, 0.93; 95% CI, 0.75-1.15）。在实施敏感肌钙蛋白测定后，2型心肌梗死或心肌损伤的发生率不成比例地增加，现在与1型心肌梗死一样频繁。2型心肌梗死或心肌损伤患者的预后较差，尽管医疗资源使用大幅增加，但在重新分类后似乎无法改变。
Lowering the diagnostic threshold for troponin is controversial because it may disproportionately increase the diagnosis of myocardial infarction in patients without acute coronary syndrome. We assessed the impact of lowering the diagnostic threshold of troponin on the incidence, management, and outcome of patients with type 2 myocardial infarction or myocardial injury. Consecutive patients with elevated plasma troponin I concentrations (≥50 ng/L; n = 2929) were classified with type 1 (50%) myocardial infarction, type 2 myocardial infarction or myocardial injury (48%), and type 3 to 5 myocardial infarction (2%) before and after lowering the diagnostic threshold from 200 to 50 ng/L with a sensitive assay. Event-free survival from death and recurrent myocardial infarction was recorded at 1 year. Lowering the threshold increased the diagnosis of type 2 myocardial infarction or myocardial injury more than type 1 myocardial infarction (672 vs 257 additional patients, P < .001). Patients with myocardial injury or type 2 myocardial infarction were at higher risk of death compared with those with type 1 myocardial infarction (37% vs 16%; relative risk [RR], 2.31; 95% confidence interval [CI], 1.98-2.69) but had fewer recurrent myocardial infarctions (4% vs 12%; RR, 0.35; 95% CI, 0.26-0.49). In patients with troponin concentrations 50 to 199 ng/L, lowering the diagnostic threshold was associated with increased healthcare resource use (P < .05) that reduced recurrent myocardial infarction and death for patients with type 1 myocardial infarction (31% vs 20%; RR, 0.64; 95% CI, 0.41-0.99), but not type 2 myocardial infarction or myocardial injury (36% vs 33%; RR, 0.93; 95% CI, 0.75-1.15). After implementation of a sensitive troponin assay, the incidence of type 2 myocardial infarction or myocardial injury disproportionately increased and is now as frequent as type 1 myocardial infarction. Outcomes of patients with type 2 myocardial infarction or myocardial injury are poor and do not seem to be modifiable after reclassification despite substantial increases in healthcare resource use.
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影响因子：
5.9
作者：
Saaby, Lotte;Poulsen, Tina Svenstrup;Mickley, Hans
通讯作者：
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Saaby, Lotte;Poulsen, Tina Svenstrup;Mickley, Hans
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