Department of Medicine, Karolinska Institutet, Solna, Sweden.
Functional area of Emergency Medicine, Karolinska University Hospital, Huddinge, Sweden.
J Intern Med. 2018 Jul;284(1):50-60. doi: 10.1111/joim.12779. Epub 2018 Jun 14.
Cardiac troponin assays have become more sensitive over the years leading to the clinical introduction of high-sensitivity cardiac troponin assays in 2010. Their use has revolutionized the assessment of patients with chest pain in the emergency department by allowing earlier rule-in and rule-out of myocardial infarction leading to shorter stays in the emergency department and reduced admissions for chest pain. The incidence of myocardial infarction has increased slightly, and patients with myocardial infarction diagnosed with high-sensitivity cardiac troponins have been found to have a reduced risk of reinfarction, though without an impact on survival. High-sensitivity cardiac troponins are powerful predictors of long-term mortality and cardiovascular disease in the general population as well as in patients with chest pain with or without cardiovascular disease. The increase in risk for death and cardiovascular disease associated with high-sensitivity cardiac troponins is graded and starts already at detectable levels, well below the upper normal level. The aim of this review was to describe the clinical use and consequences of the introduction of high-sensitivity cardiac troponins. In addition, the importance of persistently elevated troponin levels for prognosis and what investigations may be appropriate to perform in patients with stable troponin elevations are discussed.
多年来，心肌肌钙蛋白检测的灵敏度不断提高，这使得高敏心肌肌钙蛋白检测于 2010 年在临床上得以应用。在急诊科，这些检测方法通过更早地排除或诊断心肌梗死，缩短了患者在急诊科的停留时间，减少了胸痛患者的住院率，从而改变了胸痛患者的评估方式。心肌梗死的发病率略有上升，而用高敏心肌肌钙蛋白诊断的心肌梗死患者被发现再梗死风险降低，但对生存没有影响。高敏心肌肌钙蛋白是一般人群以及有或无心血管疾病的胸痛患者发生长期死亡和心血管疾病的有力预测指标。与高敏心肌肌钙蛋白相关的死亡和心血管疾病风险增加是分级的，并且已经在可检测水平开始，远低于正常上限。本综述旨在描述高敏心肌肌钙蛋白的临床应用及其带来的影响。此外，还讨论了持续升高的肌钙蛋白水平对预后的重要性，以及对于稳定升高的肌钙蛋白患者应进行哪些检查。
