Medizinische Klinik, Abteilung für Innere Medizin III, Universitätsklinikum Heidelberg, Germany.
Clin Chem. 2015 May;61(5):744-51. doi: 10.1373/clinchem.2014.235317. Epub 2015 Mar 3.
Diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) varies depending on presenting symptoms in patients with suspected acute coronary syndrome (ACS).
We compared performance measures of hs-cTnT among patients admitted to the emergency department with typical chest pain (angina), dyspnea, and atypical symptoms and assessed outcomes by leading presenting symptoms.
A total of 658 patients suspected of ACS and presenting with typical chest pain (n = 241, 36.6%), dyspnea (n = 142, 21.6%), or atypical symptoms (n = 275, 41.8%) were included. Diagnostic accuracy of hs-cTnT on admission was higher among patients with typical chest pain compared to those with atypical symptoms [area under the curve (AUC) 0.823 vs AUC 0.776 vs AUC 0.705, P > 0.05 and P = 0.04]. Absolute concentration changes within 6 h improved accuracy among all subgroups, with the smallest added benefit in typical chest pain and dyspnea (ΔAUC, 0.078; P = 0.02 and 0.05, P > 0.05). During 1-year follow-up, dyspnea was associated with a higher risk of death (hazard ratio, 2.36; 95% CI, 1.26-4.43, P = 0.008) and death/AMI (hazard ratio, 2.23; 95% CI, 1.21-4.11, P = 0.01) compared to typical chest pain. Optimal discriminating values for hs-cTnT were higher among patients presenting with dyspnea compared to those with typical chest pain (91.2 vs 14.1 ng/L, P < 0.001).
The diagnostic performance of hs-cTnT in patients with suspected ACS depends on the leading presenting symptom. Patients admitted with dyspnea represent a high-risk cohort in which the diagnosis of ACS is less frequent and with inferior performance of serial hs-cTnT measurements. Higher hs-cTnT cutoffs at baseline and absolute changes after 6 h help to identify non-STEMI (ST segment elevation myocardial infarction) in this population.
高敏心肌肌钙蛋白 T（hs-cTnT）的诊断性能因疑似急性冠状动脉综合征（ACS）患者的临床表现而有所不同。
我们比较了急诊科因典型胸痛（心绞痛）、呼吸困难和非典型症状就诊的患者中 hs-cTnT 的性能指标，并根据主要临床表现评估了结局。
共纳入 658 例疑似 ACS 且表现为典型胸痛（n=241，36.6%）、呼吸困难（n=142，21.6%）或非典型症状（n=275，41.8%）的患者。与非典型症状患者相比，具有典型胸痛的患者入院时 hs-cTnT 的诊断准确性更高[曲线下面积（AUC）0.823 比 AUC 0.776 比 AUC 0.705，P>0.05 和 P=0.04]。6 h 内的 hs-cTnT 绝对浓度变化可提高所有亚组的准确性，在典型胸痛和呼吸困难患者中获益最小（ΔAUC，0.078；P=0.02 和 0.05，P>0.05）。在 1 年随访期间，呼吸困难与死亡（危险比，2.36；95%可信区间，1.26-4.43，P=0.008）和死亡/急性心肌梗死（危险比，2.23；95%可信区间，1.21-4.11，P=0.01）的风险升高相关，与典型胸痛相比。与具有典型胸痛的患者相比，呼吸困难患者的 hs-cTnT 最佳鉴别值更高（91.2 比 14.1 ng/L，P<0.001）。
hs-cTnT 在疑似 ACS 患者中的诊断性能取决于主要临床表现。因呼吸困难就诊的患者代表一个高危人群，其中 ACS 的诊断频率较低，连续 hs-cTnT 测量的性能较差。基线时更高的 hs-cTnT 截止值和 6 h 后的绝对变化有助于识别该人群中的非 ST 段抬高心肌梗死（ST 段抬高心肌梗死）。
