Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial Infarction.
Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial Infarction.
复制标题
DOI：
10.1056/nejmoa0903515
复制
发表时间：
2009-08-27
影响因子：
158.5
通讯作者：
Blankenberg, Stefan
中科院分区：
文献类型：
--
作者：
Keller, Till;Zeller, Tanja;Blankenberg, Stefan
背景：心肌肌钙蛋白检测是急性心肌梗死诊断的核心。我们评估了一种敏感的肌钙蛋白I测定法用于心肌梗死的早期诊断和风险分层。方法：在一项多中心研究中，我们测定了1818例连续疑似急性心肌梗死患者在入院时、入院后3小时和6小时的肌钙蛋白I、肌钙蛋白T和传统心肌坏死标志物的水平。结果：对于入院时获得的样本，与肌钙蛋白T测定（AUC, 0.85）和传统心肌坏死标志物相比，敏感肌钙蛋白I测定（受体工作特征曲线下面积[AUC]， 0.96）的诊断准确性最高。入院时采用敏感肌钙蛋白1测定（临界值0.04 ng / ml），临床敏感性为90.7%，特异性为90.2%。无论胸痛发作的时间如何，基线和系列样本的诊断准确性几乎相同。在胸痛发作后3小时内出现的患者中，单次敏感肌钙蛋白I检测的阴性预测值为84.1%，阳性预测值为86.7%；这些发现预示着6小时内肌钙蛋白I水平会上升30%肌钙蛋白I水平超过0.04 ng / ml与30天不良结果风险增加独立相关（风险比1.96；95%可信区间1.27 ~ 3.05；P=0.003）。结论：使用肌钙蛋白I的敏感检测可以提高急性心肌梗死的早期诊断和风险分层，而与胸痛发作的时间无关。中华医学杂志，2009;31(1):868- 877。
Background: Cardiac troponin testing is central to the diagnosis of acute myocardial infarction. We evaluated a sensitive troponin I assay for the early diagnosis and risk stratification of myocardial infarction.Methods: In a multicenter study, we determined levels of troponin I as assessed by a sensitive assay, troponin T, and traditional myocardial necrosis markers in 1818 consecutive patients with suspected acute myocardial infarction, on admission and 3 hours and 6 hours after admission.Results: For samples obtained on admission, the diagnostic accuracy was highest with the sensitive troponin I assay (area under the receiver-operating-characteristic curve [AUC], 0.96), as compared with the troponin T assay (AUC, 0.85) and traditional myocardial necrosis markers. With the use of the sensitive troponin I assay (cutoff value, 0.04 ng per milliliter) on admission, the clinical sensitivity was 90.7%, and the specificity was 90.2%. The diagnostic accuracy was virtually identical in baseline and serial samples, regardless of the time of chest-pain onset. In patients presenting within 3 hours after chest-pain onset, a single sensitive troponin I assay had a negative predictive value of 84.1% and a positive predictive value of 86.7%; these findings predicted a 30% rise in the troponin I level within 6 hours. A troponin I level of more than 0.04 ng per milliliter was independently associated with an increased risk of an adverse outcome at 30 days (hazard ratio, 1.96; 95% confidence interval, 1.27 to 3.05; P=0.003).Conclusions: The use of a sensitive assay for troponin I improves early diagnosis of acute myocardial infarction and risk stratification, regardless of the time of chest-pain onset.N Engl J Med 2009;361:868-77.