Cook G, Taylor D, France M, Burrows G, Manning E, Lyratzopoulos G, McElduff P, Lewis P, Martin M, Heller R F
Consultant in Public Health Medicine, The Willows, Stepping Hill Hospital, Stockport NHS Trust, Poplar Grove, Stockport SK2 7JE, UK.
QJM. 2005 Apr;98(4):275-82. doi: 10.1093/qjmed/hci045. Epub 2005 Mar 10.
Cardiac troponin T (cTnT) has an accepted place in the management of patients presenting with suspected acute coronary syndrome (ACS). Uncertainty remains about the significance and interpretation of elevated cTnT below the cut-off levels defining myocardial infarction (0.1 microg/l).
To compare the mortality risks for elevation of cTnT in the ranges 0.01-0.029 microg/l, 0.03-0.099 microg/l and <0.01 microg/l.
Retrospective record study in three hospitals.
All cTnT measurements with values in the range >0.01-0.099 microg/l analysed during January 2002 were extracted from clinical biochemistry laboratory databases. Following agreed exclusion criteria, 179 patients with cTnT in the range 0.01-0.099 microg/l and 60 patients <0.01 microg/l were selected at random from across the three sites. Six-month follow-up was completed by review of case notes and contact with the patients' GP.
There was a graded increase in mortality with increasing cTnT, although only achieving statistical significance for patients in the 0.03-0.099 microg/l range. The graded increase in relative risk with cTnT was weaker after adjustment for potential confounding factors
We found a trend for worse survival with increasing cTnT within the range 0.01-0.099 microg/l in unselected patient populations presenting with possible acute coronary syndrome. This suggests that the combined effects of assay imprecision and co-morbidity should be taken into account when interpreting borderline elevation of cTnT. The use of a cut-off based on current standards of assay precision should be used to define the sensitivity of cTnT as biochemical evidence of ischaemic cardiac damage and as an indicator of mortality risk. This level is likely to be between 0.03 and 0.1 microg/l.
心肌肌钙蛋白T（cTnT）在疑似急性冠状动脉综合征（ACS）患者的管理中具有公认的地位。对于低于定义心肌梗死的临界值（0.1微克/升）的cTnT升高的意义和解读仍存在不确定性。
比较cTnT在0.01 - 0.029微克/升、0.03 - 0.099微克/升和<0.01微克/升范围内升高时的死亡风险。
在三家医院进行的回顾性记录研究。
从临床生物化学实验室数据库中提取2002年1月期间分析的所有cTnT测量值在>0.01 - 0.099微克/升范围内的结果。根据商定的排除标准，从三个地点随机选择了179例cTnT在0.01 - 0.099微克/升范围内的患者和60例cTnT<0.01微克/升的患者。通过查阅病例记录并与患者的全科医生联系完成了为期六个月的随访。
随着cTnT升高，死亡率呈分级增加，尽管仅在0.03 - 0.099微克/升范围内的患者中达到统计学显著性。在对潜在混杂因素进行调整后，cTnT相对风险的分级增加较弱。
我们发现在未选择的可能患有急性冠状动脉综合征的患者群体中，cTnT在0.01 - 0.099微克/升范围内升高时，生存趋势随cTnT升高而变差。这表明在解释cTnT的临界升高时应考虑检测不精确性和合并症的综合影响。应使用基于当前检测精度标准的临界值来定义cTnT作为缺血性心脏损伤的生化证据以及死亡风险指标的敏感性。该水平可能在0.03至0.1微克/升之间。
