Institute for Biomedicine of Ageing, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
Aging Clin Exp Res. 2012 Jun;24(3):290-4. doi: 10.3275/7927. Epub 2011 Sep 26.
The new high sensitivity cardiac Troponin T (cTnThs) assay has recently been introduced in our clinic and ensures higher sensitivity than the fourth-generation cardiac troponin T (cTnT) assay from the same manufacturer (Roche Diagnostics). We determined the diagnostic performance of the cTnThs compared with the cTnT assay in geriatric patients, especially those with non-ST elevation myocardial infarction (NSTE- MI).
We retrospectively analysed 253 patients (age 82 ± 8 years; 82 men, 172 women) with diagnoses of suspected NSTEMI admitted to our Department of Geriatric Medicine. Patients were divided into one group of 113 patients using cTnThs, and another of 140 patients using cTnT for diagnosis. Each group included patients at the same months but different years, in either cTnThs or cTnT assays. NSTEMI was diagnosed according to current guidelines.
Baseline characteristics were similar in both groups. The proportions of patients with elevated cardiac troponin (cTn) levels significantly increased from 35% in the cTnT group to 76% in the cTnThs group (p<0.001), although no coronary cause for the elevated cTn levels was shown in about two-thirds of these patients. In patients with NSTE- MI, 58% in the cTnThs group vs 42% in the cTnT group were diagnosed within 4 hours of the onset of symptoms, whereas 42% in the cTnThs group vs 58% in the cTnT group were diagnosed more than 4 hours later (p=0.018).
The prevalence of elevated cTn has more than doubled with the use of cTnThs. However, no coronary cause was found in two-thirds of our geriatric patients, al- though more NSTEMI patients were diagnosed earlier by cTnThs.
新的高敏心肌肌钙蛋白 T（cTnThs）检测最近已在我院推出，与同一制造商（罗氏诊断公司）的第四代心肌肌钙蛋白 T（cTnT）检测相比，其具有更高的灵敏度。我们比较了 cTnThs 与 cTnT 检测在老年患者中的诊断性能，特别是非 ST 段抬高型心肌梗死（NSTE-MI）患者。
我们回顾性分析了我院老年医学科收治的 253 例疑似 NSTE-MI 患者（年龄 82±8 岁，82 名男性，172 名女性）。将患者分为使用 cTnThs 的 113 例患者组和使用 cTnT 的 140 例患者组。两组中各包含处于相同月份但不同年份的患者，他们分别接受了 cTnThs 或 cTnT 检测。NSTE-MI 的诊断依据现行指南。
两组患者的基线特征相似。cTn 水平升高的患者比例从 cTnT 组的 35%显著增加至 cTnThs 组的 76%（p<0.001），尽管约三分之二的这些患者升高的 cTn 水平没有冠状动脉原因。在 NSTE-MI 患者中，cTnThs 组 58%的患者在症状发作后 4 小时内确诊，而 cTnT 组 42%的患者在症状发作后 4 小时内确诊，cTnThs 组 42%的患者在症状发作后 4 小时后确诊，而 cTnT 组 58%的患者在症状发作后 4 小时后确诊（p=0.018）。
使用 cTnThs 后，cTn 升高的患病率增加了一倍多。然而，我们的老年患者中有三分之二的患者没有冠状动脉原因，尽管 cTnThs 能更早地诊断出更多的 NSTE-MI 患者。
