Faculdade de Medicina da Bahia, Salvador, BA, Brazil.
Arq Bras Cardiol. 2012 May;98(5):406-12. doi: 10.1590/s0066-782x2012005000034. Epub 2012 Apr 5.
Despite superior diagnostic accuracy of high-sensitivity cardiac troponins, their prognostic value has not been validated against conventional cardiac troponins.
To test the prognostic value of high-sensitivity cardiac troponin I (hs-cTnI), compared with conventional cardiac troponin T (cTnT) in the setting of non-ST elevation acute coronary syndromes.
At hospital admission, a plasma sample was collected from 103 consecutive patients with unstable angina or non-ST elevation acute myocardial infarction. In this sample, troponin was measured both by hs-cTnI and cTnT methods. Their prognostic value was compared as to the occurrence of major cardiovascular events, defined as a combination of death, nonfatal acute myocardial infarction or refractory unstable angina during hospitalization.
During median hospitalization of 8 days (interquartile range = 5 - 11), the incidence of cardiovascular events was 10% (5 deaths, 3 non-fatal myocardial infarctions and 2 non-fatal refractory anginas). High-sensitivity troponin I significantly predicted cardiovascular events, with a C-statistics of 0.73 (95% CI = 0.59 - 0.87), similarly to cTnT (0.70; 95% CI = 0.55 - 0.84) - P = 0.75. The definition of positive cardiac marker that provided the best prognostic accuracy was hs-cTnI > 0.055 µg/L and cTnT > 0.010 µg/L, with equal sensitivity of 90% and specificity of 52% for both assays. Positive hs-cTnI was associated with 17% incidence of events, compared with 2% in patients with negative hs-cTnI (P = 0.02).
High-sensitivity troponin I predicts cardiovascular events similarly to conventional troponin T in the setting of non-ST-elevation ACS.
尽管高敏心肌肌钙蛋白（hs-cTnI）具有较高的诊断准确性，但尚未针对非 ST 段抬高型急性冠脉综合征（ACS）对其预后价值进行验证。
检测高敏心肌肌钙蛋白 I（hs-cTnI）与常规心肌肌钙蛋白 T（cTnT）相比，在非 ST 段抬高型 ACS 中的预后价值。
在入院时，连续采集 103 例不稳定型心绞痛或非 ST 段抬高型急性心肌梗死患者的血浆样本。在此样本中，同时使用 hs-cTnI 和 cTnT 方法测量肌钙蛋白。比较两种方法对主要心血管事件（住院期间死亡、非致死性急性心肌梗死或难治性不稳定型心绞痛的组合）发生的预后价值。
在中位数 8 天（四分位间距 5-11）的住院期间，心血管事件的发生率为 10%（5 例死亡，3 例非致死性心肌梗死和 2 例非致死性难治性心绞痛）。高敏肌钙蛋白 I 可显著预测心血管事件，C 统计量为 0.73（95%CI = 0.59-0.87），与 cTnT 相似（0.70；95%CI = 0.55-0.84）-P = 0.75。提供最佳预后准确性的阳性标志物定义为 hs-cTnI > 0.055 µg/L 和 cTnT > 0.010 µg/L，两种检测方法的灵敏度均为 90%，特异性均为 52%。hs-cTnI 阳性患者的事件发生率为 17%，而 hs-cTnI 阴性患者的事件发生率为 2%（P = 0.02）。
在非 ST 段抬高型 ACS 中，高敏肌钙蛋白 I 预测心血管事件的能力与常规肌钙蛋白 T 相似。
