Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction
Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction
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DOI：
10.1373/clinchem.2018.298059
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发表时间：
2019-03-01
影响因子：
9.3
通讯作者：
Mills, Nicholas L.
中科院分区：
文献类型：
--
作者：
Anand, Atul;Shah, Anoop S., V;Mills, Nicholas L.
背景技术背景：心肌梗死的通用定义（UMI）定义了心肌梗死的诊断和治疗方法。高灵敏度的心肌肌钙蛋白测试，建议，因为这些检测方法在低浓度下提高了精度，但对特异性的关注可能会限制其implementation.METHODS：我们进行了一项全球性的调查，1902医疗中心在23个国家均匀分布在5大洲，以评估通过的主要建议，从USCWA。参与疑似急性冠状动脉综合征患者的诊断和管理的受访者完成了一个结构化的电话问卷，详细介绍了主要的生物标志物，诊断阈值，用于识别心肌infaration.RESULTS的临床路径：心肌肌钙蛋白是主要的诊断生物标志物在96%的调查网站。只有41%的研究中心采用了高灵敏度检测，从北美的7%到欧洲的60%。与使用上一代检测试剂盒的研究中心相比，使用高灵敏度肌钙蛋白的研究中心更频繁地使用连续采样途径（91% vs 78%）和第99百分位诊断阈值（74% vs 66%）。此外，高灵敏度机构更经常使用较早的系列抽样（
BACKGROUND: The universal definition of myocardial infarction (UDMI) standardizes the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing is recommended because these assays have improved precision at low concentrations, but concerns over specificity may have limited their implementation.METHODS: We undertook a global survey of 1902 medical centers in 23 countries evenly distributed across 5 continents to assess adoption of key recommendations from the UDMI. Respondents involved in the diagnosis and management of patients with suspected acute coronary syndrome completed a structured telephone questionnaire detailing the primary biomarker, diagnostic thresholds, and clinical pathways used to identify myocardial infarction.RESULTS: Cardiac troponin was the primary diagnostic biomarker at 96% of surveyed sites. Only 41% of centers had adopted high-sensitivity assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity troponin more frequently used serial sampling pathways (91% vs 78%) and the 99th percentile diagnostic threshold (74% vs 66%) than sites using previous-generation assays. Furthermore, highsensitivity institutions more often used earlier serial sampling (