Sandoval Yader, Thordsen Sarah E, Smith Stephen W, Schulz Karen M, Murakami MaryAnn M, Pearce Lesly A, Apple Fred S
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, USA.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, USA.
Eur Heart J Acute Cardiovasc Care. 2014 Dec;3(4):317-25. doi: 10.1177/2048872614538411. Epub 2014 Jun 25.
To determine the ability of serial cardiac troponin (cTnI) changes (delta) to distinguish type 1 and type 2 myocardial infarction (MI) (excluding all ST-segment elevation MIs (STEMIs)) and describe the diagnostic accuracy and 180-day mortality in MI versus no-MI patients.
Serial cTnIs were measured in 1112 consecutive patients without STEMI and within 6h of presentation to a United States emergency department: 856 (77%) with no MI, 66 (6%) type 1 MI, and 190 (17%) type 2 MI. Of the 0 to 3h and 0 to 6h absolute and relative cTnI changes, only the distribution of absolute change from 0 to 6h was significantly different between type 1 and type 2 MI: median (interquartile range) 311 (1430) ng/l vs. 80 (330) ng/l, p=0.03. Neither the absolute concentration change nor the absolute percent change from either 0 h to 3h (areas under the curves (AUCs) 0.57 and 0.54 respectively) or 0 h to 6h (AUCs 0.60 and 0.51) improved on the performance of the individual cTnI results at 3h (AUC 0.60) or 6h (AUC 0.62), respectively. After adjusting for age, and histories of heart failure and renal insufficiency, those with type 2 MI (hazard ratio 2.9, 95% confidence interval (CI) 1.4-5.9, p=0.004) and those with no index MI and cTnI(max0-6h) > 34 ng/l (2.5, CI 1.1-6.0, p=0.04) had increased risk of death within 180 days compared with those with no MI and cTnI(max 0-6h) ≤ 34 ng/l.
Delta cTnI did not aid in distinguishing type 1 MI from the more common type 2 MI. Patients diagnosed with type 2 MIs, which represented more than half of all index MIs, had increased risk of death after discharge.
确定连续心肌肌钙蛋白（cTnI）变化量（delta）区分1型和2型心肌梗死（MI）（不包括所有ST段抬高型心肌梗死（STEMI））的能力，并描述MI患者与非MI患者的诊断准确性及180天死亡率。
对1112例无STEMI且在美国急诊科就诊6小时内的连续患者测量连续cTnI：856例（77%）无MI，66例（6%）为1型MI，190例（17%）为2型MI。在0至3小时和0至6小时的cTnI绝对变化量和相对变化量中，只有0至6小时的绝对变化量分布在1型和2型MI之间存在显著差异：中位数（四分位间距）为311（1430）ng/l 对比80（330）ng/l，p = 0.03。从0小时至3小时（曲线下面积（AUC）分别为0.57和0.54）或0小时至6小时（AUC分别为0.60和0.51）的绝对浓度变化量和绝对百分比变化量，在3小时（AUC 0.60）或6小时（AUC 0.62）的个体cTnI结果表现上均未有所改善。在调整年龄、心力衰竭和肾功能不全病史后，与无MI且cTnI（max0 - 6h）≤ 34 ng/l的患者相比，2型MI患者（风险比2.9，95%置信区间（CI）1.4 - 5.9，p = 0.004）以及无首次MI且cTnI（max0 - 6h）> 34 ng/l的患者（2.5，CI 1.1 - 6.0，p = 0.04）在180天内死亡风险增加。
cTnI变化量无助于区分1型MI和更常见的2型MI。诊断为2型MI的患者占所有首次MI患者的一半以上，出院后死亡风险增加。
