High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography.
High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography.
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DOI：
10.1161/circulationaha.109.893826
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发表时间：
2010-03-16
期刊：
影响因子：
37.8
通讯作者：
Koenig W
中科院分区：
文献类型：
--
作者：
Januzzi JL Jr;Bamberg F;Lee H;Truong QA;Nichols JH;Karakas M;Mohammed AA;Schlett CL;Nagurney JT;Hoffmann U;Koenig W
对于胸痛和疑似急性冠状动脉综合征（ACS）患者的评价，共识指南建议使用对应于健康人群第99百分位数的心肌肌钙蛋白临界点。大多数常规肌钙蛋白方法在这个非常低的水平上缺乏足够的精确度。在一项横断面研究中，377例胸痛和低至中等ACS可能性的患者（平均年龄53.7岁，64.2%为男性）入组急诊科。使用商业化前的高灵敏度肌钙蛋白T测定（hsTnT）检测血液，并与传统的心肌肌钙蛋白T方法（cTnT）进行比较。患者在静脉切开术时接受64层冠状动脉计算机断层扫描（CT）冠状动脉血管造影，平均4小时，从最初的表现。在急性胸痛患者中，37例（9.8%）有ACS。使用健康人群的第99百分位数临界点（13 pg/mL），hsTnT对ACS的敏感性为62%，特异性为89%，阳性预测值为38%，阴性预测值为96%。与cTnT相比，hsTnT检测到的ACS病例多27%（P = 0.001），hsTnT高于第99百分位数强烈预测ACS（比值比9.0，95%置信区间3.9-20.9; P <0.001）。独立于ACS诊断，CT血管造影显示hsTnT浓度由许多因素决定，包括冠状动脉疾病的存在和严重程度以及左心室质量、左心室射血分数和局部左心室功能障碍。在低至中等风险的胸痛患者中，hsTnT为ACS提供了良好的敏感性和特异性。高敏肌钙蛋白T的升高可鉴别出心肌损伤和显著结构性心脏病的患者，而与ACS的诊断无关。
For evaluation of patients with chest pain and suspected acute coronary syndrome (ACS), consensus guidelines recommend use of a cardiac troponin cut-point that corresponds to the 99th percentile of a healthy population. Most conventional troponin methods lack sufficient precision at this very low level. In a cross-sectional study, 377 patients (mean age 53.7 years, 64.2% male) with chest pain and low-to-intermediate likelihood for ACS were enrolled in the emergency department. Blood was tested using a pre-commercial high sensitivity troponin T assay (hsTnT) and compared to a conventional cardiac troponin T method (cTnT). Patients underwent a 64-slice coronary computed tomography (CT) coronary angiogram at the time of phlebotomy, on average 4 hours from initial presentation. Among patients with acute chest pain, 37 (9.8%) had an ACS. Using the 99th percentile cut-point for a healthy population (13 pg/mL), hsTnT had 62% sensitivity, 89% specificity, 38% positive predictive value, and 96% negative predictive value for ACS. Compared to cTnT, hsTnT detected 27% more ACS cases (P =.001), and an hsTnT above the 99th percentile strongly predicted ACS (odds ratio 9.0, 95% confidence interval 3.9–20.9; P <.001). Independent of ACS diagnosis, CT angiography demonstrated concentrations of hsTnT were determined by numerous factors including the presence and severity of coronary artery disease as well as left ventricular mass, left ventricular ejection fraction, and regional left ventricular dysfunction. Among low-to-intermediate risk patients with chest pain, hsTnT provides good sensitivity and specificity for ACS. Elevation of hsTnT identifies patients with myocardial injury and significant structural heart disease, irrespective of the diagnosis of ACS.