Department of Cardiology, University Hospital, Basel, Switzerland.
Am J Med. 2012 Dec;125(12):1205-1213.e1. doi: 10.1016/j.amjmed.2012.07.015.
The study objective was to compare the incidence and prognosis of acute myocardial infarction when using high-sensitivity cardiac troponin assays instead of a standard cardiac troponin assay for the diagnosis of acute myocardial infarction.
In a prospective international multicenter study, we enrolled 1124 consecutive patients presenting with suspected acute myocardial infarction. Final diagnoses were adjudicated by 2 independent cardiologists 2 times using all available clinical information: first using standard cardiac troponin levels and second using high-sensitivity cardiac troponin T levels for adjudication. Patients were followed up for a mean of 19±9 months.
The use of high-sensitivity cardiac troponin T instead of standard cardiac troponin resulted in an increase in the incidence of acute myocardial infarction from 18% to 22% (242 vs 198 patients), a relative increase of 22%. Of the 44 additional acute myocardial infarctions, 35 were type 1 acute myocardial infarctions and 9 were type 2 acute myocardial infarctions. This was accompanied by a reciprocal decrease in the incidence of unstable angina (unstable angina, 11% vs 13%). The most pronounced increase was observed in patients adjudicated with cardiac symptoms of origin other than coronary artery disease with cardiomyocyte damage (83 vs 31 patients, relative increase of 268%). Cumulative 30-month mortality rates were 4.8% in patients without acute myocardial infarction, 16.4% in patients with a small acute myocardial infarction detected only by high-sensitivity cardiac troponin T but not standard cardiac troponin, and 23.9% in patients with a moderate/large acute myocardial infarction according to standard cardiac troponin assays and high-sensitivity cardiac troponin T (P<.001).
The introduction of high-sensitivity cardiac troponin assays leads to only a modest increase in the incidence of acute myocardial infarction. The novel sensitive assays identify an additional high-risk group of patients with increased mortality, therefore appropriately classified with acute myocardial infarction (Advantageous Predictors of Acute Coronary Syndromes Evaluation; NCT00470587).
本研究旨在比较使用高敏心肌肌钙蛋白检测替代标准心肌肌钙蛋白检测对急性心肌梗死（acute myocardial infarction，AMI）进行诊断时 AMI 的发生率和预后。
在一项前瞻性国际多中心研究中，我们连续纳入了 1124 例疑似 AMI 患者。最终诊断由 2 位独立的心脏病专家根据所有可用的临床信息进行 2 次裁决：首次使用标准心肌肌钙蛋白水平，第二次使用高敏心肌肌钙蛋白 T 水平进行裁决。患者平均随访 19±9 个月。
与标准心肌肌钙蛋白相比，使用高敏心肌肌钙蛋白 T 检测可使 AMI 的发生率从 18%增加到 22%（242 例比 198 例），相对增加 22%。在这 44 例额外的 AMI 中，35 例为 1 型 AMI，9 例为 2 型 AMI。同时不稳定型心绞痛的发生率也相应下降（不稳定型心绞痛，11%比 13%）。在被判定为心脏症状源于冠状动脉疾病以外的心肌细胞损伤的患者中，这种变化最为明显（83 例比 31 例，相对增加 268%）。在无 AMI 的患者中，30 个月的累积死亡率为 4.8%；在仅通过高敏心肌肌钙蛋白 T 检测而不是标准心肌肌钙蛋白检测发现小面积 AMI 的患者中，死亡率为 16.4%；在根据标准心肌肌钙蛋白和高敏心肌肌钙蛋白 T 检测发现中等/大面积 AMI 的患者中，死亡率为 23.9%（P＜0.001）。
高敏心肌肌钙蛋白检测的引入仅使 AMI 的发生率略有增加。新型敏感检测方法确定了死亡率增加的另外一个高危患者群体，因此可以适当地将其分类为 AMI（急性冠状动脉综合征优势预测因子评估；NCT00470587）。
