Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Am Heart J. 2013 May;165(5):716-24. doi: 10.1016/j.ahj.2013.02.008. Epub 2013 Mar 26.
Sensitive troponin assays have substantially improved early diagnosis of myocardial infarction. However, the role of sensitive cardiac troponin (cTn) assays in prediction of significant coronary lesions and long-term prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS) remains unresolved.
This prospective study includes 458 consecutive patients with NSTE-ACS admitted for coronary angiography. Serum levels of 4 commercial available sensitive troponin assays were analyzed (Roche high-sensitive cTnT [hs-cTnT; Roche Diagnostics, Basel, Switzerland], Siemens cTnI Ultra [Siemens, Munich, Germany], Abbott-Architect cTnI [Abbott, Abbott Park, IL], Access Accu-cTnI [Beckman Coulter, Nyon, Switzerland]), as well as a standard assay (Roche cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), before coronary angiography.
The relationship between the analyzed biomarkers and significant coronary lesions on coronary angiography, as quantified by area under the receiver operating characteristic curve, was significantly higher with Roche hs-cTnT, Siemens cTnI Ultra, and Access Accu-cTnI as compared with standard troponin T assay (P < .001 for all comparisons). This difference was mainly caused by increased sensitivity below the 99th percentile. Also, NT-proBNP was associated with the presence of significant coronary lesions. Cardiac troponin values were correlated with cardiac death (primary end point) during 1373 (1257-1478) days of follow-up. In both univariate and multivariate Cox regression analyses, NT-proBNP was superior to both hs-cTnT and cTnI in prediction of cardiovascular mortality. Troponin values with all assays were correlated with the need for repeated revascularization (secondary end point) during follow-up.
Sensitive cTn assays are superior to standard cTnT assay in prediction of significant coronary lesions in patients with NSTE-ACS. However, this improvement is primary caused by increased sensitivity below the 99th percentile. N-terminal pro-B-type natriuretic peptide is superior to cTns in prediction of long-term mortality.
敏感肌钙蛋白检测极大地提高了心肌梗死的早期诊断。然而，在非 ST 段抬高型急性冠状动脉综合征（NSTE-ACS）中，敏感肌钙蛋白检测在预测显著冠状动脉病变和长期预后方面的作用仍未解决。
这项前瞻性研究纳入了 458 例因冠状动脉造影而入院的 NSTE-ACS 连续患者。分析了 4 种市售的敏感肌钙蛋白检测（罗氏高敏肌钙蛋白 T[hs-cTnT；罗氏诊断公司，巴塞尔，瑞士]、西门子肌钙蛋白 I 超敏[西门子，慕尼黑，德国]、雅培-Architect 肌钙蛋白 I[雅培，雅培公园，IL]、贝克曼库尔特 Access Accu-cTnI[贝克曼库尔特，尼永，瑞士]）以及标准检测（罗氏 cTnT）和 N 末端 pro-B 型利钠肽（NT-proBNP）在冠状动脉造影前的血清水平。
与标准肌钙蛋白 T 检测相比，通过受试者工作特征曲线下面积定量的分析生物标志物与冠状动脉造影显示的显著冠状动脉病变之间的关系，罗氏 hs-cTnT、西门子 cTnI 超敏和 Access Accu-cTnI 显著更高（所有比较 P<.001）。这种差异主要是由于 99 百分位以下的敏感性增加所致。此外，NT-proBNP 与显著冠状动脉病变的存在相关。肌钙蛋白值与 1373（1257-1478）天的随访期间的心脏性死亡（主要终点）相关。在单变量和多变量 Cox 回归分析中，NT-proBNP 在预测心血管死亡率方面优于 hs-cTnT 和 cTnI。所有检测的肌钙蛋白值与随访期间需要再次血运重建（次要终点）相关。
在 NSTE-ACS 患者中，敏感肌钙蛋白检测优于标准 cTnT 检测预测显著冠状动脉病变。然而，这种改善主要是由于 99 百分位以下的敏感性增加所致。N 末端 pro-B 型利钠肽在预测长期死亡率方面优于 cTns。
