Wassef Anthony Wafik Aziz, Hiebert Brett, Saeed Mahwash F, Tam James W
Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Can J Physiol Pharmacol. 2015 Oct;93(10):873-7. doi: 10.1139/cjpp-2014-0473. Epub 2015 Mar 20.
The novel high-sensitivity troponin T assay (hs-cTnT) has been validated for diagnosing AMI in the emergency room. However its utility in high-risk in-patient populations is unknown.
We retrospectively reviewed admissions to a general cardiology unit that had 2 hs-cTnT measurements in the first 12 h of presentation. We assessed 8 diagnostic algorithms that used hs-cTnT concentration and changes in concentration (including the 99th percentile cut-off of 14 ng/L) for their diagnostic utility in separating AMI patients from cardiac/nonACS and non-cardiac chest-pain patients. UA was excluded.
There were 233 patients (mean age 67 years, 153 were males (66%)) admitted over a 2 month period, with AMI diagnosed in 118 of these patients (51%). The recommended 99th percentile cut-off had modest accuracy (65%), good sensitivity (88%), and poor specificity (25%); a higher cut-off of 75 ng/L had a better diagnostic accuracy of 73%, p < 0.05. While some hs-cTnT algorithms were either highly sensitive or specific, none were both.
In high-risk cardiology in-patients, no hs-cTnT concentration cut-off or change more accurately diagnosed and excluded AMI, although higher cut-offs had better diagnostic utility.
新型高敏肌钙蛋白T检测法（hs-cTnT）已被证实可用于急诊室急性心肌梗死（AMI）的诊断。然而，其在高危住院患者中的效用尚不清楚。
我们回顾性分析了普通心脏病科病房的入院患者，这些患者在就诊后的前12小时内进行了2次hs-cTnT检测。我们评估了8种诊断算法，这些算法使用hs-cTnT浓度及其浓度变化（包括第99百分位数截断值14 ng/L），以确定其在区分AMI患者与心脏/非急性冠状动脉综合征（non-ACS）及非心脏性胸痛患者方面的诊断效用。排除了不稳定型心绞痛（UA）。
在2个月的时间里，共收治了233例患者（平均年龄67岁，其中153例为男性（66%）），其中118例（51%）被诊断为AMI。推荐的第99百分位数截断值具有中等准确性（65%）、良好的敏感性（88%）和较差的特异性（25%）；75 ng/L的较高截断值具有更好的诊断准确性，为73%，p<0.05。虽然一些hs-cTnT算法要么具有高度敏感性，要么具有高度特异性，但没有一种算法同时具备这两种特性。
在高危心脏病住院患者中，没有hs-cTnT浓度截断值或变化能更准确地诊断和排除AMI，尽管较高的截断值具有更好的诊断效用。
