Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Diseases, Marshall University School of Medicine, Huntington, WV; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN.
Mayo Clin Proc. 2024 Sep;99(9):1435-1442. doi: 10.1016/j.mayocp.2023.12.019. Epub 2024 Mar 16.
To evaluate the diagnostic performance of the previously recommended baseline high-sensitivity cardiac troponin T (hs-cTnT) thresholds of 52 and 100 ng/L in identifying patients at high risk of acute myocardial infarction (AMI).
This study compared the positive predictive value (PPV) for index AMI of these high-risk hs-cTnT thresholds in adult patients in the emergency department undergoing hs-cTnT measurement.
The adjudicated MAyo Southwest Wisconsin 5th Gen Troponin T ImplementatiON cohort included 2053 patients, with 157 (7.6%) who received a diagnosis of AMI. The hs-cTnT concentrations of greater than 52 and greater than 100 ng/L resulted in PPVs of 41% (95% CI, 35%-48%) and 57% (95% CI, 48%-66%). In patients with chest discomfort, hs-cTnT concentrations greater than 52 ng/L resulted in a PPV of 66% (95% CI, 56%-76%) and hs-cTnT concentrations greater than 100 ng/L resulted in a PPV of 77% (95% CI, 65%-87%). The CV Data Mart Biomarker cohort included 143,709 patients, and 3003 (2.1%) received a diagnosis of AMI. Baseline hs-cTnT concentrations greater than 52 and greater than 100 ng/L resulted in PPVs of 12% (95% CI, 11%-12%) and 17% (95% CI, 17%-19%), respectively. In patients with chest pain and hs-cTnT concentrations greater than 52 ng/L, the PPV for MI was 17% (95% CI, 15%-18%) and in those with concentrations greater than 100 ng/L, only 22% (95% CI, 19%-25%).
In unselected patients undergoing hs-cTnT measurement, the hs-cTnT thresholds of greater than 52 and greater than 100 ng/L provide suboptimal performance for identifying high-risk patients. In patients with chest discomfort, an hs-cTnT concentration of greater than 100 ng/L, but not the European Society of Cardiology-recommended threshold of greater than 52 ng/L, provides an acceptable performance but should be used only with other clinical features.
评估先前推荐的基线高敏心肌肌钙蛋白 T（hs-cTnT）阈值 52ng/L 和 100ng/L 用于识别急性心肌梗死（AMI）高危患者的诊断性能。
本研究比较了在急诊接受 hs-cTnT 测量的成年患者中，这些高危 hs-cTnT 阈值对索引 AMI 的阳性预测值（PPV）。
经裁决的 Mayo 西南威斯康星州第五代 Troponin T 实施队列纳入了 2053 例患者，其中 157 例（7.6%）被诊断为 AMI。hs-cTnT 浓度大于 52ng/L 和大于 100ng/L 的 PPV 分别为 41%（95%CI，35%-48%）和 57%（95%CI，48%-66%）。在有胸痛的患者中，hs-cTnT 浓度大于 52ng/L 的 PPV 为 66%（95%CI，56%-76%），hs-cTnT 浓度大于 100ng/L 的 PPV 为 77%（95%CI，65%-87%）。CV Data Mart Biomarker 队列纳入了 143709 例患者，其中 3003 例（2.1%）被诊断为 AMI。基线 hs-cTnT 浓度大于 52ng/L 和大于 100ng/L 的 PPV 分别为 12%（95%CI，11%-12%）和 17%（95%CI，17%-19%）。在有胸痛和 hs-cTnT 浓度大于 52ng/L 的患者中，MI 的 PPV 为 17%（95%CI，15%-18%），在浓度大于 100ng/L 的患者中，仅为 22%（95%CI，19%-25%）。
在接受 hs-cTnT 测量的未经选择的患者中，hs-cTnT 阈值大于 52ng/L 和大于 100ng/L 对识别高危患者的性能不佳。在有胸痛的患者中，hs-cTnT 浓度大于 100ng/L，但不是欧洲心脏病学会推荐的大于 52ng/L 的阈值，提供了可接受的性能，但应仅与其他临床特征一起使用。
