Wilson Gibbs, Barkley Kyler, Slicker Kipp, Kowal Robert, Pope Brandon, Michel Jeffrey
Department of Internal Medicine, Scott and White Memorial Hospital, Temple, TX.
Department of Cardiology, Scott and White Memorial Hospital, Temple, TX.
J Hosp Med. 2017 May;12(5):329-331. doi: 10.12788/jhm.2732.
Troponin assays are integral to the diagnosis of acute myocardial infarction (AMI), but there is concern that testing is over utilized and may not conform to published guidelines. We reviewed all testing performed at 14 hospitals over 12 months and associated troponin values with the primary and secondary diagnoses for each visit. Troponin was determined to be negative, indeterminate or elevated based on reference ranges. The majority of troponin measurements were single, not serial (64%). The rate of AMI was low, with only 3.5% of tested patients having a primary or secondary diagnosis of AMI. Sensitivity, specificity and negative predictive value were excellent, exceeding 90%. However, positive predictive value was low, suggesting testing of populations with diseases known to be associated with elevated troponin levels in the absence of AMI. The majority (79%) of elevated troponin values were associated with primary diagnoses other than AMI. Only 28% of elevated troponins were associated with a primary or secondary diagnosis of AMI. These data suggest possible overuse of troponin testing in our healthcare system. Journal of Hospital Medicine 2017;12:329-331.
肌钙蛋白检测对于急性心肌梗死（AMI）的诊断至关重要，但有人担心检测存在过度使用的情况，且可能不符合已发表的指南。我们回顾了14家医院在12个月内进行的所有检测，并将每次就诊的肌钙蛋白值与主要和次要诊断相关联。根据参考范围，肌钙蛋白被确定为阴性、不确定或升高。大多数肌钙蛋白测量是单次的，而非系列测量（64%）。AMI的发生率较低，仅3.5%的检测患者有AMI的主要或次要诊断。敏感性、特异性和阴性预测值都很高，超过90%。然而，阳性预测值较低，这表明在没有AMI的情况下，对已知与肌钙蛋白水平升高相关疾病的人群进行了检测。大多数（79%）肌钙蛋白值升高与AMI以外的主要诊断相关。只有28%的肌钙蛋白升高与AMI的主要或次要诊断相关。这些数据表明我们的医疗系统中可能存在肌钙蛋白检测过度使用的情况。《医院医学杂志》2017年；12:329 - 331。
