Vidali Matteo, Verzotti Enrica, Cabraz Nicole, Santi Francesca, Puma Alessia, Bellomo Giorgio, Lupi Alessandro, Lippi Giuseppe, Avanzi Gian Carlo
Dipartimento di Scienze della Salute, Universitŕ del Piemonte Orientale, Novara, Italy.
Dipartimento di Medicina Traslazionale, Universitŕ del Piemonte Orientale, Novara, Italy.
Biochem Med (Zagreb). 2015 Oct 15;25(3):421-9. doi: 10.11613/BM.2015.043. eCollection 2015.
The aim of this study was to identify clinical variables which may be independently associated with positivity of a cardiac troponin I (cTnI) assay in a large population of patients admitted to the emergency department (ED).
3166 subjects, with at least two troponin I tests ordered within 6 hours in the ED, were studied. Patient data were statistically analyzed to identify clinical associations with increased values of Troponin I.
Although patients with diagnosis of acute coronary syndrome displayed troponin I values significantly higher than those of other groups, positivity to troponin I (>40 ng/L) was also observed in patients with other clinical conditions. In multivariate analysis, age, elevated heart rate and electrocardiographic changes were independently associated with troponin I positivity at admission. In the whole study population troponin I positivity exhibited high sensitivity and negative predictive value, counterbalanced by low specificity and limited positive predictive value.
Troponin I positivity should be combined with history and clinical evaluation and cautiously interpreted in the ED, especially in patients exhibiting factors associated with higher troponin I levels such as older age, elevated heart rate or ECG changes.
本研究的目的是在大量急诊科（ED）收治的患者中，确定可能与心肌肌钙蛋白I（cTnI）检测阳性独立相关的临床变量。
对3166名在急诊科6小时内至少接受两次肌钙蛋白I检测的受试者进行了研究。对患者数据进行统计分析，以确定与肌钙蛋白I值升高相关的临床关联。
尽管诊断为急性冠状动脉综合征的患者肌钙蛋白I值显著高于其他组，但在其他临床情况下的患者中也观察到肌钙蛋白I阳性（>40 ng/L）。在多变量分析中，年龄、心率升高和心电图变化与入院时肌钙蛋白I阳性独立相关。在整个研究人群中，肌钙蛋白I阳性表现出高敏感性和阴性预测价值，但特异性低和阳性预测价值有限。
在急诊科，肌钙蛋白I阳性应结合病史和临床评估，并谨慎解读，尤其是在那些表现出与较高肌钙蛋白I水平相关因素的患者中，如年龄较大、心率升高或心电图变化。
