Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction
Utility of Absolute and Relative Changes in Cardiac Troponin Concentrations in the Early Diagnosis of Acute Myocardial Infarction
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DOI：
10.1161/circulationaha.111.023937
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发表时间：
2011-07-12
期刊：
影响因子：
37.8
通讯作者：
Mueller, Christian
中科院分区：
文献类型：
--
作者：
Reichlin, Tobias;Irfan, Affan;Mueller, Christian
背景-目前诊断急性心肌梗死（AMI）的指南，除其他标准外，还要求心肌肌钙蛋白（cTn）水平升高和/或降低。这是未知的，无论是绝对或相对变化，肌钙蛋白有较高的诊断准确性，因此应该是prefered.Methods和结果，在一个前瞻性的，观察性的，多中心研究，我们分析了诊断准确性的绝对（三角洲）和相对（三角洲%）的变化，肌钙蛋白在836例急诊室的症状提示急性心肌梗死。在就诊时以及1小时和2小时后以设盲方式采集用于测定高灵敏度cTn T和cTn I ultra的血样。最终诊断由2名独立心脏病专家裁定。诊断AMI的2小时绝对（Delta）cTn变化的受试者工作特征曲线下面积显著高于2小时相对（Delta%）cTn变化（受试者工作特征曲线下面积[95%可信区间]，高灵敏度cTn T：0.95 [0.92 ~ 0.98] vs 0.76 [0.70 ~ 0.83]，P < 0.001; cTnI ultra：0.95 [0.91至0.99]对比0.72 [0.66至0.79]，P < 0.001）。对于高灵敏度cTn T和cTn I ultra，2小时绝对（Delta）变化的受试者工作特征曲线推导的临界值分别为0.007 μ g/L和0.020 μ g/L（两个临界水平均为相应cTn检测试剂第99百分位数的一半）。绝对变化是上级相对变化的患者低和升高的基线cTn level. Conclusions，绝对变化的cTn水平有一个显着较高的诊断准确性AMI比相对变化，因此似乎是首选的标准，以区分AMI从其他原因的cTn升高。
Background-Current guidelines for the diagnosis of acute myocardial infarction (AMI), among other criteria, also require a rise and/or fall in cardiac troponin (cTn) levels. It is unknown whether absolute or relative changes in cTn have higher diagnostic accuracy and should therefore be preferred.Methods and Results-In a prospective, observational, multicenter study, we analyzed the diagnostic accuracy of absolute (Delta) and relative (Delta%) changes in cTn in 836 patients presenting to the emergency department with symptoms suggestive of AMI. Blood samples for the determination of high-sensitive cTn T and cTn I ultra were collected at presentation and after 1 and 2 hours in a blinded fashion. The final diagnosis was adjudicated by 2 independent cardiologists. The area under the receiver operating characteristic curve for diagnosing AMI was significantly higher for 2-hour absolute (Delta) versus 2-hour relative (Delta%) cTn changes (area under the receiver operating characteristic curve [95% confidence interval], high-sensitivity cTn T: 0.95 [0.92 to 0.98] versus 0.76 [0.70 to 0.83], P < 0.001; cTn I ultra: 0.95 [0.91 to 0.99] versus 0.72 [0.66 to 0.79], P < 0.001). The receiver operating characteristic curve-derived cutoff value for 2-hour absolute (Delta) change was 0.007 mu g/L for high-sensitivity cTn T and 0.020 mu g/L for cTn I ultra (both cutoff levels are half of the 99th percentile of the respective cTn assay). Absolute changes were superior to relative changes in patients with both low and elevated baseline cTn levels.Conclusions-Absolute changes of cTn levels have a significantly higher diagnostic accuracy for AMI than relative changes, and seem therefore to be the preferred criteria to distinguish AMI from other causes of cTn elevations.