Nowak Richard, Mueller Christian, Giannitsis Evangelos, Christ Michael, Ordonez-Llanos Jordi, DeFilippi Christopher, McCord James, Body Richard, Panteghini Mauro, Jernberg Tomas, Plebani Mario, Verschuren Franck, French John K, Christenson Robert, Jacobsen Gordon, Dinkel Carina, Lindahl Bertil
a Emergency Medicine , Henry Ford Hospital , Detroit , MI , USA.
b Department of Cardiology & Cardiovascular Research Institute Basel , University Hospital Base , Basel , Switzerland.
Biomarkers. 2017 Dec;22(8):709-714. doi: 10.1080/1354750X.2017.1334154. Epub 2017 Jun 14.
To describe the baseline, 1 hr and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis.
hs-cTnT assay for RAPID rule out of acute myocardial infarction (TRAPID-AMI) was a prospective diagnostic trial that enrolled emergency department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin. The baseline, 1 hr and delta hs-cTnT values were analysed in the 902 non-ACS patients.
Amongst the 1282 studied the patient groups were 213 (17%) AMI, 167 (13%) unstable angina, 113 (9%) non-ACS cardiac, 288 (22%) non-cardiac and 501 (39%) unknown origin. The hs-cTnT values in the non-cardiac and unknown origin groups were combined. The median hs-cTnT values (ng/L) were higher (p < 0.001) in the non-ACS cardiac compared to the non-cardiac/unknown origin group at baseline (11.8, <5) and 1 hr (12.3, <5). Their negative predictive values were 0.955 (baseline) and 0.954 (1 hr) for predicting non-ACS cardiac versus non-cardiac/unknown origin diagnoses.
Hs-cTnT may help predict whether non-ACS ED patients have a final non-ACS cardiac or non-cardiac/unknown origin diagnoses.
描述疑似急性心肌梗死（AMI）但最终未确诊为急性冠状动脉综合征（ACS）患者的基线、1小时及高敏心肌肌钙蛋白（hs-cTnT）变化值。
用于快速排除急性心肌梗死的hs-cTnT检测（TRAPID-AMI）是一项前瞻性诊断试验，纳入了急诊科疑似AMI患者。最终患者诊断由临床事件委员会判定，受试者被分为不同临床组：AMI、不稳定型心绞痛、非ACS心脏疾病、非心脏疾病及病因不明。对902例非ACS患者的基线、1小时及hs-cTnT变化值进行了分析。
在1282例研究对象中，患者组包括213例（17%）AMI、167例（13%）不稳定型心绞痛、113例（9%）非ACS心脏疾病、288例（22%）非心脏疾病及501例（39%）病因不明。将非心脏疾病组和病因不明组的hs-cTnT值合并。在基线时（11.8，<5）和1小时时（12.3，<5），非ACS心脏疾病组的hs-cTnT中位数（ng/L）高于非心脏疾病/病因不明组（p<0.001）。其预测非ACS心脏疾病与非心脏疾病/病因不明诊断的阴性预测值分别为0.955（基线）和0.954（1小时）。
Hs-cTnT可能有助于预测非ACS急诊科患者最终诊断为非ACS心脏疾病还是非心脏疾病/病因不明。
