de Winter R J, Sanders G T
Afd. Klinische en Experimentele Cardiologie, Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam.
Ned Tijdschr Geneeskd. 2001 Mar 10;145(10):461-6.
The diagnosis of 'myocardial infarction' was recently redefined by a commission of European and American cardiologists. The main element of the new definition is a raised serum level of heart-specific troponin (T or I). In healthy adults virtually no cardiac troponin is demonstrable, so that every rise of the level of the heart-specific troponin in the blood means that there is myocardial damage. An infarction during a coronary bypass operation and myocardial damage during skeletomuscular injury can be diagnosed almost faultlessly by a troponin assay. A raised troponin level in acute coronary ischaemia is associated with a raised mortality risk. However, even when the level is normal, a risk of cardiac complications is present. For the diagnosis of a recurrent infarction during a developing infarction, determination of the peak level of the creatine kinase muscle brain mass (CK-MBmass) is most appropriate. Also, the value of including troponin in the existing rule-out protocols has not yet been proven. Now that most Dutch hospitals shortly will be capable of troponin assays, cardiologists and clinical chemists should consider the implementation of this assay in clinical practice.
“心肌梗死”的诊断最近由一个欧美心脏病专家委员会重新定义。新定义的主要要素是血清中心脏特异性肌钙蛋白（T或I）水平升高。在健康成年人中，几乎检测不到心脏肌钙蛋白，因此血液中心脏特异性肌钙蛋白水平的每一次升高都意味着存在心肌损伤。通过肌钙蛋白检测，几乎可以无误地诊断冠状动脉搭桥手术期间的梗死以及骨骼肌损伤期间的心肌损伤。急性冠状动脉缺血时肌钙蛋白水平升高与死亡风险增加相关。然而，即使水平正常，也存在心脏并发症的风险。对于在进展性梗死期间诊断复发性梗死，测定肌酸激酶同工酶质量（CK-MBmass）的峰值最为合适。此外，将肌钙蛋白纳入现有的排除方案中的价值尚未得到证实。鉴于大多数荷兰医院不久后将能够进行肌钙蛋白检测，心脏病专家和临床化学家应考虑在临床实践中实施这种检测。
