Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay
Defining a reference population to determine the 99th percentile of a contemporary sensitive cardiac troponin I assay
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DOI：
10.1016/j.ijcard.2012.04.063
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发表时间：
2013-08-20
影响因子：
3.5
通讯作者：
Lackner, Karl J.
中科院分区：
文献类型：
--
作者：
Keller, Till;Ojeda, Francisco;Lackner, Karl J.
背景资料：根据通用定义，急性心肌梗死（AMI）的诊断基于缺血症状、影像学检查结果和心肌坏死标志物升高，最好是心肌肌钙蛋白I/T，诊断阈值代表参考人群的第99百分位数。对于心脏病，这是一个基于特定人群的队列，还是一个健康队列，尚不明确。本研究的目的是使用一种敏感的检测方法来描述肌钙蛋白I的分布，并评估心脏疾病和心血管危险因素对表面健康个体的影响。肌钙蛋白I测定采用当代灵敏度测定法（TnI Ultra，Siemens），变异系数10%（0.03 ng/mL）低于公布的第99百分位数古滕贝格健康研究（一项基于社区的、前瞻性、观察性单中心队列研究）的5000名参与者（49.2%为女性）中的血清肌酐水平（0.04 ng/mL）。在1818名疑似AMI患者中测试了计算出的第99百分位数临界值。结果：代表整个研究人群第99百分位数的肌钙蛋白I浓度为0.04 ng/mL。排除患有流行性心血管疾病的个体将第99百分位数降低至0.034 ng/mL。排除具有传统风险因素或利钠肽升高的个体导致进一步降低0.029/0.028 ng/mL。这些较低的临界值在疑似AMI的个体中检测到更多的风险患者。结论：表面健康者的肌钙蛋白I浓度与心血管疾病的患病率、传统危险因素、性别和年龄有关。在AMI诊断中应用相应的临界值改变了潜在风险的患者组。(C)2012爱思唯尔爱尔兰有限公司保留所有权利。
Background: Diagnosis of acute myocardial infarction (AMI) according to the universal definition is based on ischemic symptoms, imaging findings and elevated myocardial necrosis markers, preferably cardiac troponin I/T with diagnostic threshold representing the 99th percentile of a reference population. It is not clearly defined if this should be an unselected population-based or a healthy cohort with respect to cardiac diseases. Aim of the current study was to describe the distribution of troponin I using a sensitive assay and to evaluate the impact of cardiac diseases and cardiovascular risk factors in apparently healthy individuals.Methods: Troponin I was determined using a contemporary sensitive assay (TnI Ultra, Siemens) with 10% coefficient of variation (0.03 ng/mL) below the published 99th percentile (0.04 ng/mL) in 5000 participants (49.2% female) of the Gutenberg Health Study, a community-based, prospective, observational single-center cohort study. The calculated 99th percentile cut-offs were tested in 1818 patients with suspected AMI.Results: Troponin I concentration representing the 99th percentile of the overall study population was 0.04 ng/mL. Excluding individuals with prevalent cardiovascular disease lowers the 99th percentile to 0.034 ng/mL. Exclusion of individuals with traditional risk factors or elevated natriuretic peptide leads to further reduction with 0.029/0.028 ng/mL. These lower cut-offs detect more patients at risk in individuals with suspected AMI. Correlations of troponin I with age, gender and traditional risk factors were observed.Conclusions: Troponin I concentrations in apparently healthy individuals are dependent on prevalent cardiovascular diseases, traditional risk factors, gender and age. Application of corresponding cut-offs in diagnosis of AMI alters the group of patients potentially at risk. (C) 2012 Elsevier Ireland Ltd. All rights reserved.