Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830, USA.
JAMA. 2013 Jun 5;309(21):2262-9. doi: 10.1001/jama.2013.5809.
Cardiac troponins are the preferred biomarkers for diagnosis of myocardial infarction because of their high sensitivity and specificity for myocardial injury. However, acute and chronic conditions distinct from acute coronary syndromes (ACS) commonly lead to small elevations in troponin levels, with few data available regarding management of care for patients with such conditions. Recently developed highly sensitive troponin assays will likely lead to a substantial increase in the proportion of detectable troponin levels attributable to non-ACS conditions. Novel algorithms with highly sensitive assays, incorporating baseline troponin values and changes in values over 1 to 2 hours, may allow rapid exclusion of myocardial infarction and help to address specificity concerns but must be validated in appropriate target populations. Enhanced detection of very low troponin levels with highly sensitive assays has made feasible several potential new indications for troponin testing, including in the ambulatory setting, where assessment for low-level chronic myocardial injury may enhance risk stratification for heart failure and cardiac death.
心肌肌钙蛋白因其对心肌损伤的高灵敏度和特异性，是诊断心肌梗死的首选生物标志物。然而，与急性冠状动脉综合征（ACS）不同的急性和慢性疾病通常会导致肌钙蛋白水平的轻微升高，而关于此类疾病患者的护理管理，可用的数据很少。最近开发的高灵敏度肌钙蛋白检测方法可能会导致归因于非 ACS 疾病的可检测肌钙蛋白水平的比例大幅增加。新型算法与高灵敏度检测方法相结合，纳入基线肌钙蛋白值和 1 至 2 小时内的变化，可能有助于快速排除心肌梗死并有助于解决特异性问题，但必须在合适的目标人群中进行验证。高灵敏度检测方法对极低水平肌钙蛋白的增强检测使肌钙蛋白检测的几个潜在新适应症成为可能，包括在门诊环境中，对低水平慢性心肌损伤的评估可能会增强心力衰竭和心脏性死亡的风险分层。
