Department of Cardiology, Monklands Hospital, Monkscourt Avenue, Airdrie, ML6 0JS, Glasgow.
QJM. 2014 Mar;107(3):193-200. doi: 10.1093/qjmed/hct232. Epub 2013 Nov 19.
Troponin testing in acute medicine is routine. The introduction of a high sensitivity assay (hs Tn T) has created uncertainty regarding the clinical significance of 'abnormal' troponin T levels. The previous assay could not detect troponin levels <30 ng/l.
To characterize those with a hs Tn T ≥14 ng/l. Prospective cohort study of consecutive admissions to an acute medical unit.
Troponin was measured in 564 consecutive patients (∼50% of all admissions) over 1 month; was ≥14 ng/l in 224 (40%) of which 220 patients had demographic data for this analysis. Median (inter-quartile range) peak troponin was 47.5 ng/l (24-130) and 36% had a Tn T between 14 and 30 ng/l. Mean [standard deviation (SD)] age was 72 (12) years and 57% were male. Only 44 patients (20%) had an acute myocardial infarction, reflecting the increased sensitivity but reduced specificity of the assay. Prognosis was poor with 31% mortality at 1 year. Over a mean (SD) follow-up of 648 (61) days, there were 87 deaths (40%). Those with a primary non-cardiac diagnosis (n = 126) had poorer survival than those with a primary cardiac diagnosis (n = 94). Troponin elevation related to sepsis conferred a very poor prognosis with 24 deaths (70%) over the follow-up period.
Elevated hs Tn T is very common in acute medicine, but myocardial infarction as an explanation is uncommon. Overall, the prognosis is poor with a tendency to worse outcomes in those with a primary 'non-cardiac' diagnosis.
在急性医学中，肌钙蛋白检测是常规操作。高敏肌钙蛋白检测（hs TnT）的应用给“异常”肌钙蛋白 T 水平的临床意义带来了不确定性。之前的检测方法无法检测到＜30ng/L 的肌钙蛋白水平。
分析 hs TnT≥14ng/L 的患者特征。这是一项对急性医学病房连续入院患者进行的前瞻性队列研究。
在 1 个月内连续检测了 564 例患者（约占所有入院患者的 50%）的肌钙蛋白水平，其中 224 例（40%）的肌钙蛋白水平≥14ng/L，这 220 例患者有此分析所需的人口统计学数据。肌钙蛋白峰值的中位数（四分位距）为 47.5ng/L（24-130），36%的患者肌钙蛋白水平在 14-30ng/L 之间。平均（标准差）年龄为 72（12）岁，57%为男性。仅有 44 例（20%）患者被诊断为急性心肌梗死，这反映了检测方法敏感性增加但特异性降低。预后较差，1 年死亡率为 31%。在平均（标准差）648（61）天的随访期间，有 87 例死亡（40%）。与原发性心脏诊断（n=94）相比，原发性非心脏诊断（n=126）患者的生存率较差。与脓毒症相关的肌钙蛋白升高预示着预后极差，在随访期间有 24 例死亡（70%）。
在急性医学中，hs TnT 升高非常常见，但作为解释的心肌梗死并不常见。总体而言，预后较差，原发性“非心脏”诊断患者的预后较差。
