Mueller-Hennessen Matthias, Giannitsis Evangelos
1Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
Diagnosis (Berl). 2016 Dec 1;3(4):175-181. doi: 10.1515/dx-2016-0023.
According to the universal definition, a diagnosis of acute myocardial infarction (AMI) can be made in the presence of a kinetic change of cardiac troponin (cTn) with at least one value above the 99th percentile of a healthy population together with clinical signs of myocardial ischemia. Thus, differences in 99th percentile cut-off values may have important diagnostic and therapeutic consequences for the correct AMI diagnosis. Following the introduction of high-sensitivity (hs) cTn assays with the ability to detect cTn in virtually every healthy individual, almost all available hs Tn assays suggest to use solitary 99th percentile cut-offs. However, several findings have questioned the use of a solitary cut-off for AMI diagnosis, as apparent age- and gender-dependent differences were found concerning the 99th percentile cut-off value. Moreover, there is an increasing number of studies which suggest a relevant diagnostic and prognostic benefit, when age- or gender-specific cut-offs values are used in comparison to general cut-offs. In contrast, other studies observed only a small impact on diagnostic reclassification and risk stratification. Given these ambiguous findings, there is currently no clear evidence for the use of age- and/or gender-dependent 99th percentiles. This review gives an overview of the rationale for gender- and age-dependent differences in cTn biomarker findings and discusses the implementation of these findings into clinical practice.
根据通用定义，在心肌肌钙蛋白（cTn）出现动态变化且至少有一个值高于健康人群第99百分位数，同时伴有心肌缺血临床症状时，可诊断为急性心肌梗死（AMI）。因此，第99百分位数临界值的差异可能对正确诊断AMI产生重要的诊断和治疗影响。随着高灵敏度（hs）cTn检测方法的引入，几乎能够在每个健康个体中检测到cTn，几乎所有现有的hs Tn检测方法都建议使用单独的第99百分位数临界值。然而，一些研究结果对使用单独的临界值诊断AMI提出了质疑，因为在第99百分位数临界值方面发现了明显的年龄和性别依赖性差异。此外，越来越多的研究表明，与通用临界值相比，使用年龄或性别特异性临界值具有相关的诊断和预后益处。相比之下，其他研究仅观察到对诊断重新分类和风险分层的影响较小。鉴于这些不明确的结果，目前尚无明确证据支持使用年龄和/或性别依赖性第99百分位数。本综述概述了cTn生物标志物结果中性别和年龄依赖性差异的基本原理，并讨论了将这些结果应用于临床实践的情况。
