Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 Sep;96(9):2366-2375. doi: 10.1016/j.mayocp.2021.01.027. Epub 2021 May 13.
To identify the diagnoses and outcomes associated with elevated high sensitivity cardiac troponin T (hs-cTnT) compared with the 4th-generation troponin T and to validate the Mayo Clinic hs-cTnT myocardial infarction algorithm cutoff values.
Consecutive blood samples of patients presenting to the emergency department between July 2017 and August 2017, who had 4th-generation troponin T, were also analyzed using the hs-cTnT assay. Troponin T values, discharge diagnoses, comorbidities, and outcomes were assessed. In addition, analyses of sex-specific and hs-cTnT cutoff values were assessed.
Of 830 patients, 32% had an elevated 4th-generation troponin T, whereas 64% had elevated hs-cTnT. With serial sampling, 4th-generation troponin missed a chronic myocardial injury pattern and acute myocardial injury pattern in 64% and 16% of patients identified with hs-cTnT, respectively. Many of these "missed" patients had discharge diagnoses associated with cardiovascular disease, infection, or were postoperative. Five of the 6 patients with unstable angina ruled in for myocardial infarction.
There were many increases in hs-cTnT that were missed by the 4th-generation cTnT assay. Most new increases are not related to acute cardiac causes. They were more consistent with chronic myocardial injury. High-sensitivity cTnT did reclassify most patients with unstable angina as having non-ST-elevation myocardial infarction. Older age, more comorbidities, and lower hemoglobin were associated with elevated hs-cTnT. Our data also support the use of our sex-specific cutoff values.
确定与第四代肌钙蛋白 T 相比，高敏心肌肌钙蛋白 T（hs-cTnT）升高相关的诊断和结局，并验证 Mayo 诊所 hs-cTnT 心肌梗死算法的截断值。
连续采集 2017 年 7 月至 2017 年 8 月间因急诊就诊的患者的血液样本，这些患者均进行了第四代肌钙蛋白 T 检测，同时也使用 hs-cTnT 检测进行分析。评估了肌钙蛋白 T 值、出院诊断、合并症和结局。此外，还评估了性别特异性和 hs-cTnT 截断值的分析。
在 830 名患者中，32%的患者第四代肌钙蛋白 T 升高，而 64%的患者 hs-cTnT 升高。通过连续采样，第四代肌钙蛋白 T 漏诊了 64%和 16%的 hs-cTnT 患者的慢性心肌损伤和急性心肌损伤模式。这些“漏诊”患者中有许多人被诊断为心血管疾病、感染或术后。不稳定型心绞痛的 6 名患者中有 5 名被诊断为心肌梗死。
hs-cTnT 升高的情况很多都被第四代 cTnT 检测漏诊。大多数新的升高与急性心脏原因无关。它们更符合慢性心肌损伤。高敏肌钙蛋白 T 确实重新分类了大多数不稳定型心绞痛患者为非 ST 段抬高型心肌梗死。年龄较大、合并症较多和血红蛋白较低与 hs-cTnT 升高相关。我们的数据还支持使用我们的性别特异性截断值。
