Croce Antonio, Brunati Pietro, Colzani Carlo, Terramocci Riccardo, Favero Stefano, Bordoni Gabriele, Galli Claudio
Department of Diagnostic Services, ASST Valtellina e Alto Lario, Sondrio, Italy.
Central Laboratory, Hospital "Valduce", Como, Italy.
Dis Markers. 2017;2017:4523096. doi: 10.1155/2017/4523096. Epub 2017 May 15.
We describe the adoption of high sensitive troponin I (hsTnI) in clinical practice in two hospital settings in Italy. Samples from 426 consecutive patients (mean age 68.8 ± 17.0) admitted to the Emergency Department with a suspected acute coronary syndrome (ACS) have been tested at admittance and after 3 and 6 hours by contemporary TnI and hsTnI. Results have been compared to the final clinical diagnosis. Troponin was detectable in 68.6% by TnI and 89.9% by hsTnI. Since hsTnI has a lower threshold for females, 38/41 patients with positive values only by hsTnI were women. The correlation between the assays was very high ( = 0.92). A diagnosis of acute myocardial infarction (AMI) was made in 45 cases (10.5%). The negative and positive predictive values for a 50% troponin variation at 3 hours were 95.8% and 66.7% for hsTnI and 95.0% and 52.6% for TnI and at 6 hours 90.3% and 100% for hsTnI and 88.9% and 78.9% for TnI, respectively. Receiver operating characteristic (ROC) curve analysis demonstrated a greater efficiency by hsTnI at 3 hours versus 6 hours (AUC = 0.91 versus 0.72). The main benefits of hsTnI are the adoption of gender-specific 99th percentile and the shortening of time to decision.
我们描述了高敏肌钙蛋白I（hsTnI）在意大利两家医院临床实践中的应用情况。对426例连续入住急诊科且疑似急性冠脉综合征（ACS）的患者（平均年龄68.8±17.0岁）的样本在入院时、3小时和6小时后同时采用传统肌钙蛋白I（TnI）和hsTnI进行检测。将结果与最终临床诊断进行比较。TnI检测到肌钙蛋白的比例为68.6%，hsTnI为89.9%。由于hsTnI对女性的阈值较低，仅hsTnI检测值为阳性的41例患者中有38例为女性。两种检测方法之间的相关性非常高（=0.92）。45例（10.5%）患者被诊断为急性心肌梗死（AMI）。hsTnI在3小时时肌钙蛋白变化50%的阴性和阳性预测值分别为95.8%和66.7%，TnI分别为95.0%和52.6%；在6小时时，hsTnI分别为90.3%和100%，TnI分别为88.9%和78.9%。受试者工作特征（ROC）曲线分析表明，hsTnI在3小时时比6小时时效率更高（曲线下面积[AUC]=0.91对0.72）。hsTnI的主要优势在于采用了性别特异性的第99百分位数，并缩短了决策时间。
