Response by Bularga et al to Letter Regarding Article, "Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study".
Response by Bularga et al to Letter Regarding Article, "Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study".
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Bularga 等人对有关文章“2 型心肌梗死患者的冠状动脉和心脏疾病：前瞻性队列研究”的回复。
DOI：
10.1161/circulationaha.122.061692
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发表时间：
2022
期刊：
影响因子：
37.8
通讯作者：
Bularga A
中科院分区：
文献类型：
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作者：
Bularga A
我们感谢Agirbasli博士和Aksoy博士就我们最近的文章所做的通信，在这篇文章中，我们报告了2型心肌梗死患者的冠状动脉和心脏成像结果。作者强调了高灵敏度心肌肌钙蛋白测定和使用固定的第99百分位数参考上限作为心肌梗死诊断阈值所带来的挑战。1高灵敏度心肌肌钙蛋白的引入使对疑似急性冠脉综合征患者的评估和对急性心肌梗死以外疾病中心肌损伤的识别有了重大改进，具有重要的预后意义。2然而，尽管取得了进展，但仍有人担心第99百分位数作为心肌梗死诊断阈值的实用性，这适用于1型和2型心肌梗死。正如作者所指出的，使用固定阈值没有充分考虑影响肌钙蛋白浓度的个体患者特征，如年龄、性别和既往合并症（如慢性肾脏疾病），也没有考虑这些变量之间的相互作用。我们最近强调，高灵敏度心肌肌钙蛋白的诊断性能明显受年龄的影响3，在实践中，仅阈值不足以区分1型心肌梗死与其他心肌损伤或梗死的原因。4在我们的研究中，1例参与者只有在其临床表现符合第四种心肌梗死通用定义的2型心肌梗死标准时才被接触。这包括心肌损伤的证据，定义为高敏心肌肌钙蛋白I浓度升高和/或降低，至少1个值高于性别特异性第99百分位数，症状
We thank Drs Agirbasli and Aksoy for their correspondence regarding our recent article in which we reported the coronary and cardiac imaging findings in patients with type 2 myocardial infarction. The authors highlight the challenge posed by high-sensitivity cardiac troponin assays and the use of a fixed 99th percentile upper reference limit as the diagnostic threshold for myocardial infarction. 1The introduction of high-sensitivity cardiac troponins has led to major improvements in the assessment of patients with suspected acute coronary syndrome and recognition of myocardial injury in conditions other than acute myocardial infarction with important prognostic implications. 2 However, despite progress, there remain concerns about the utility of the 99th percentile as the diagnostic threshold for myocardial infarction, which is applicable to both type 1 and type 2 myocardial infarction. As the authors point out, the use of a fixed threshold does not adequately take into consideration individual patient characteristics that influence troponin concentrations, such as age, sex, and prior comorbidities (eg, chronic kidney disease), and it does not take into account interaction between these variables. We recently highlighted that the diagnostic performance of high-sensitivity cardiac troponin is markedly influenced by age3 and thresholds alone are insufficient to distinguish type 1 myocardial infarction from other causes of myocardial injury or infarction in practice. 4 In our study, 1 participants were only approached if their clinical presentation fulfilled the Fourth Universal Definition of Myocardial Infarction criteria for type 2 myocardial infarction. This included evidence of myocardial injury defined as a rise and/or fall in high-sensitivity cardiac troponin I concentration with at least 1 value above the sex-specific 99th percentile, symptoms