Fitzgerald Gerald, Kerley R N, Kiernan Thomas J
Department of Cardiology, University Hospital Limerick, Limerick, Ireland.
Expert Rev Cardiovasc Ther. 2019 Oct;17(10):763-770. doi: 10.1080/14779072.2019.1675514. Epub 2019 Oct 9.
: The introduction of cardiac troponin (cTn) assays have revolutionized the diagnosis and management of acute myocardial infarction in Emergency Departments worldwide. Its success has led to significant research and development investment in this area culminating in the development of newer high-sensitivity cardiac troponin assays (hs-cTn). While these newer assays allow for more rapid diagnosis by decreasing the time interval between serial data points, there is an inevitable trade off between increasing sensitivity and specificity. This review examines in detail the introduction and implementation of hs-cTN and its implications for clinical practice.: This article reviews the history and development of high-sensitivity troponin assays and their application to clinical practice and current evidence base. It also discusses both the positive and negative aspects of the continuing increasing sensitivity of biochemical assays and the translation of this into clinical practice. Potential future developments are also discussed.: It is clear that there are many benefits to detecting extremely low concentration of cardiac troponin including the development of rapid rule out algorithms and the cost and time-saving advantages associated with the quicker movement of patients through the health-care system. It is important to note however that detecting troponin at very low concentrations also dramatically increases the false-positive rates and leads to a potentially large increase in invasive testing and diagnosis of myocardial infarction.
心肌肌钙蛋白（cTn）检测方法的引入彻底改变了全球急诊科对急性心肌梗死的诊断和管理。其成功促使在该领域进行了大量的研发投资，最终开发出更新的高敏心肌肌钙蛋白检测方法（hs-cTn）。虽然这些更新的检测方法通过缩短连续数据点之间的时间间隔实现了更快速的诊断，但在提高灵敏度和特异性之间不可避免地存在权衡。本综述详细探讨了hs-cTn的引入和应用及其对临床实践的影响。本文回顾了高敏肌钙蛋白检测方法的历史和发展及其在临床实践中的应用和当前的证据基础。它还讨论了生化检测灵敏度持续提高的积极和消极方面，以及将其转化为临床实践的情况。还讨论了潜在的未来发展。显然，检测极低浓度的心肌肌钙蛋白有许多好处，包括开发快速排除算法以及与患者在医疗系统中更快流转相关的成本和时间节省优势。然而，需要注意的是，检测极低浓度的肌钙蛋白也会显著增加假阳性率，并导致心肌梗死侵入性检测和诊断的潜在大幅增加。
