Wildi Karin, Reichlin Tobias, Twerenbold Raphael, Mäder Fabienne, Zellweger Christa, Moehring Berit, Stallone Fabio, Minners Jan, Rubini Gimenez Maria, Hoeller Rebeca, Murray Karsten, Sou Seoung Mann, Mueller Mira, Denhaerynck Kris, Mosimann Tamina, Reiter Miriam, Haaf Philip, Meller Bernadette, Freidank Heike, Osswald Stefan, Mueller Christian
Department of Cardiology, University Hospital Basel, Switzerland; Department of Internal Medicine, University Hospital, Basel, Switzerland.
Int J Cardiol. 2013 Oct 9;168(4):4103-10. doi: 10.1016/j.ijcard.2013.07.078. Epub 2013 Jul 31.
Current guidelines require a change (rise and/or fall) in levels of cardiac troponin (cTn) for the diagnosis of acute myocardial infarction (AMI). It is unknown whether absolute or relative changes provide higher accuracy when using high-sensitivity cTnI assays.
In a prospective international multicentre study, we assessed the diagnostic accuracy of early absolute and relative changes in cTnI measured with two novel pre-commercial high-sensitivity assays (Siemens and Beckman Coulter) in 943 unselected patients presenting to the ED with suspected AMI. The final diagnosis of AMI was adjudicated using all available data including serial hs-cTnT levels by two independent cardiologists.
The diagnostic accuracy of absolute changes in the diagnosis of AMI as quantified by the area under the receiver operating characteristics curve (AUC) was very high (e.g. at 2 h, Siemens high-sensitivity cTnI AUC 0.93, 95%Cl 0.90-0.96; Beckman Coulter high-sensitivity cTnI AUC 0.93, 95%Cl 0.90-0.96) and superior to relative changes at all time points (p < 0.001). The results were consistent in clinically important subgroups. Direct comparison of the absolute changes in the two high-sensitivity cTnI assays showed similar accuracy. When combined with the baseline cTnI levels, the difference between absolute and relative changes became much smaller and remained statistically significant only for the Siemens assay.
As single variables early absolute changes in high-sensitivity cTnI levels have significantly higher diagnostic accuracy than relative changes. When combined with the baseline cTn level, reflecting clinical practice, both absolute and relative changes provided very high accuracy with much smaller differences between both approaches.
目前的指南要求心肌肌钙蛋白（cTn）水平有变化（升高和/或降低）才能诊断急性心肌梗死（AMI）。使用高敏cTnI检测时，绝对值变化还是相对值变化能提供更高的准确性尚不清楚。
在一项前瞻性国际多中心研究中，我们评估了用两种新型商业前高敏检测方法（西门子和贝克曼库尔特）测定的cTnI早期绝对值和相对值变化对943例因疑似AMI就诊于急诊科的未选择患者的诊断准确性。AMI的最终诊断由两名独立心脏病专家使用所有可用数据（包括连续hs-cTnT水平）进行判定。
用接受者操作特征曲线下面积（AUC）量化的AMI诊断中绝对值变化的诊断准确性非常高（例如，在2小时时，西门子高敏cTnI的AUC为0.93，95%CI为0.90 - 0.96；贝克曼库尔特高敏cTnI的AUC为0.93，95%CI为0.90 - 0.96），且在所有时间点均优于相对值变化（p < 0.001）。在临床重要亚组中结果一致。两种高敏cTnI检测方法的绝对值变化直接比较显示准确性相似。当与基线cTnI水平结合时，绝对值和相对值变化之间的差异变得小得多，且仅西门子检测方法在统计学上仍有显著差异。
作为单一变量，高敏cTnI水平的早期绝对值变化比相对值变化具有显著更高的诊断准确性。在反映临床实践的情况下，当与基线cTn水平结合时，绝对值和相对值变化均提供了非常高的准确性，两种方法之间的差异要小得多。
