Acute coronary syndrome vs nonspecific troponin elevation - Clinical predictors and survival analysis
Acute coronary syndrome vs nonspecific troponin elevation - Clinical predictors and survival analysis
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DOI：
10.1001/archinte.167.3.276
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发表时间：
2007-02-12
影响因子：
--
通讯作者：
Lotan, Chaim
中科院分区：
文献类型：
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作者：
Alcalai, Ronny;Planer, David;Lotan, Chaim
背景：虽然肌钙蛋白被认为是诊断急性冠脉综合征（ACS）的特异性标志物，但最近的研究表明，在多种非缺血性疾病中肌钙蛋白升高。我们的目的是确定在肌钙蛋白水平异常的情况下诊断ACS的预测因素。方法：对所有肌钙蛋白T水平异常的患者进行分析。收集了人口统计学和临床数据，并记录了死亡情况。研究组分为2个亚组：ACS vs非血栓性肌钙蛋白升高。采用多变量logistic回归分析确定预测ACS诊断的变量。计算ACS诊断的阳性预测值（PPV），并进行生存分析。结果：在研究期间，615例患者肌钙蛋白T水平升高。只有326例（53%）的主要诊断为ACS，而254例（41%）是非血栓性肌钙蛋白升高；35例（6%）患者诊断不确定。年龄在40 - 70岁之间、有高血压或缺血性心脏病史、肾功能正常、肌钙蛋白T水平高于1.0 ng/mL是ACS诊断的阳性预测因子。肌钙蛋白T对ACS诊断的总PPV仅为56% （95% CI, 52%-60%）。在肾功能正常的情况下，肌钙蛋白T水平高于1.0 ng/mL的PPV为90%，而在老年肾功能衰竭患者中，肌钙蛋白T水平在0.1 ~ 1.0 ng/mL之间的PPV低至27%。住院和长期生存率显著提高(P
Background: Although troponin is considered a specific marker for the diagnosis of acute coronary syndrome (ACS), recent studies have shown troponin elevation in a variety of nonischemic conditions. Our aim was to determine the predictors for the diagnosis of ACS in the presence of an abnormal troponin level.Methods: All patients with abnormal troponin T levels were analyzed. Demographic and clinical data were collected and death was recorded. The study group was divided into 2 subgroups: ACS vs nonthrombotic troponin elevation. Amultivariate logistic regression analysis was performed to define variables that predict the diagnosis of ACS. The positive predictive value (PPV) for ACS diagnosis was calculated, and a survival analysis was performed.Results: During the study period, 615 patients had elevated troponin T levels. Only 326 patients (53%) received a main diagnosis of ACS, while 254 (41%) had nonthrombotic troponin elevation; for 35 patients (6%), the diagnosis was not conclusive. Positive predictors for the diagnosis of ACS were age between 40 and 70 years, history of hypertension or ischemic heart disease, normal renal function, and a troponin T level higher than 1.0 ng/mL. The overall PPV of troponin T for ACS diagnosis was only 56% (95% CI, 52%-60%). The PPV of troponin T level higher than 1.0 ng/mL in the presence of normal renal function was 90% but was as low as 27% for values of 0.1 to 1.0 ng/mL for elderly patients with renal failure. In-hospital and long-term survival rates were significantly better (P