Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in U.S. Adults.
Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in U.S. Adults.
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DOI：
10.1016/j.jacc.2023.03.403
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发表时间：
2023-05-23
影响因子：
24
通讯作者：
Selvin, Elizabeth
中科院分区：
文献类型：
--
作者：
McEvoy, John W.;Tang, Olive;Wang, Dan;Ndumele, Chiadi E.;Coresh, Josef;Christenson, Robert H.;Selvin, Elizabeth
心肌损伤定义为心肌肌钙蛋白高于健康参考人群性别特异性的第99百分位数（参考上限，URL）。估计具有代表性的美国成年人群的高敏感性肌钙蛋白url；总的来说，按性别、种族/民族和年龄组分列。在参与1999-2004年全国健康与营养调查（NHANES）的成年人中，我们使用一种测定法（罗氏）测量了高肌钙蛋白-t，使用三种测定法（雅培、西门子和Ortho）测量了高肌钙蛋白- i。在严格定义的健康参考亚组中，我们使用推荐的非参数方法估计每个检测的第99百分位url。在12545名参与者中，2746名符合健康亚组标准（平均年龄37岁，50%为男性）。hs-肌钙蛋白-t的NHANES第99百分位URL （19 ng/L）与制造商报告的URL （19 ng/L）相匹配。雅培hs-troponin-I（制造商：28 ng/L）的NHANES url为13 ng/L (95% CI 10,15), Ortho hs-troponin-I（制造商：11 ng/L）的NHANES url为5 ng/L (95% CI 4,7)，西门子hs-troponin-I（制造商：46.5 ng/L）的NHANES url为37 ng/L （95% CI 276,66）。性别之间的url存在显著差异，但种族/民族之间没有差异。此外，与≥60岁的健康成人相比，<40岁的健康成人的所有四种hs-肌钙蛋白测定的第99百分位url在统计学上显著降低（秩和检验均p<0.001）。我们发现hs-肌钙蛋白- 1检测的url远远低于目前列出的第99百分位url。在健康的美国成年人中，hs-肌钙蛋白-t和hs-肌钙蛋白- i的url在性别和年龄组之间存在显著差异，但在种族/民族之间没有差异。我们发现，在美国成年人中，hs-肌钙蛋白-t和hs-肌钙蛋白- i的第99百分位url在性别和年龄方面存在显著差异，但在种族/民族方面没有差异。性别和年龄特异性的肌钙蛋白url可能是确定成人心肌损伤存在的必要条件。虽然心肌损伤目前被定义为肌钙蛋白高于健康参考人群性别特异性的第99百分位数，但种族/民族和年龄组对高敏感性（hs）心肌肌钙蛋白第99百分位数的影响更具争议。在对美国普通成年人的分析中（国家健康和营养检查调查），我们发现hs-肌钙蛋白- 1测定的第99百分位数大大低于基于制造商报告的url的预期。hs-肌钙蛋白-t和hs-肌钙蛋白- i的url在性别和年龄上有显著差异，但在种族/民族上没有差异。性别和年龄特异性的第99百分位肌钙蛋白url可能是确定成人心肌损伤存在的必要条件。
Myocardial injury is defined as a cardiac troponin above the sex-specific 99th percentile (upper reference limit, URL) of a healthy reference population. To estimate high-sensitivity (hs) troponin URLs that are representative of the US adult population; overall and by sex, race/ethnicity, and age group. Among adults participating in the 1999–2004 National Health and Nutrition Examination Survey (NHANES), we measured hs-troponin-T using one assay (Roche) and hs-troponin-I using three assays (Abbott, Siemens, and Ortho). In a strictly defined healthy reference subgroup, we estimated 99th percentile URLs for each assay using the recommended non-parametric method. Of 12,545 participants, 2,746 met criteria for the healthy subgroup (mean age 37 years, 50% male). The NHANES 99th percentile URL for hs-troponin-T (19 ng/L) matched the manufacturer-reported URL (19 ng/L). NHANES URLs were 13 ng/L (95% CI 10, 15) for Abbott hs-troponin-I (manufacturer: 28 ng/L), 5 ng/L (95% CI 4, 7) for Ortho hs-troponin-I (manufacturer: 11 ng/L), and 37 ng/L (95% CI 27, 66) for Siemens hs-troponin-I (manufacturer: 46.5 ng/L). There were significant differences in URLs by sex, but none by race/ethnicity. Furthermore, the 99th percentile URLs for all four hs-troponin assays were statistically significantly lower in healthy adults aged <40 years compared to ≥60 years (all p<0.001 by rank sum testing). We found URLs for hs-troponin-I assays that were substantially lower than currently listed 99th percentile URLs. There were significant differences in hs-troponin-T and hs-troponin-I URLs by sex and by age group in healthy US adults but none by race/ethnicity. We found significant differences in hs-troponin-T and hs-troponin-I 99th percentile URLs by sex and age in US adults, but none by race/ethnicity. Sex- and age-specific hs-troponin URLs may be necessary to determine the presence of myocardial injury in adults. While myocardial injury is currently defined as a troponin above the sex-specific 99th percentile of a healthy reference population, the impact of race/ethnicity and age group on high-sensitivity (hs) cardiac troponin 99th percentiles is more controversial. In this analysis of participants from the general US adult population (National Health and Nutrition Examination Survey), we found 99th percentiles for hs-troponin-I assays that were substantially lower than expected based on manufacturer-reported URLs. There were significant differences in hs-troponin-T and hs-troponin-I URLs by sex and age, but none by race/ethnicity. Sex- and age-specific 99th percentile hs-troponin URLs may be necessary to determine the presence of myocardial injury in adults.
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影响因子：
6.8
作者：
Collinson, Paul O.;Saenger, Amy K.;Todd, John
通讯作者：
Todd, John
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影响因子：
2.9
作者：
Dietl A;Zimmermann ME;Brandl C;Wallner S;Burkhardt R;Maier LS;Luchner A;Heid IM;Stark KJ
通讯作者：
Stark KJ
影响因子：
3.5
作者：
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通讯作者：
Maciejko, James J.
影响因子：
5
作者：
Egger, Margot;Dieplinger, Benjamin;Mueller, Thomas
通讯作者：
Mueller, Thomas
影响因子：
9.3
作者：
Apple, Fred S.;Ler, Ranka;Murakami, MaryAnn M.
通讯作者：
Murakami, MaryAnn M.