Grittani Agostino, Ramos Saul, Gomez Chabelly, Varela Cesar A, Puri Nikhil, Zarry Samantha, Suarez Jose H
Internal Medicine, St. George's University, Toronto, CAN.
Internal Medicine, University of Medicine and Health Sciences, Saint Kitts, KNA.
Cureus. 2024 Jun 30;16(6):e63538. doi: 10.7759/cureus.63538. eCollection 2024 Jun.
Non-ST segment elevation myocardial infarction (NSTEMI) is an acute coronary syndrome event where myocardial ischemia is present, with an increase of cardiac troponins without an elevation of the ST segment. One of the fundamental measures used to diagnose or rule out acute coronary syndrome (ACS) is troponin levels in the blood. Troponin is a broad term used for the category of muscle contraction regulatory proteins and is commonly measured during ACS evaluation. Troponin I is only released by cardiac tissue, while some assay measurements will also pick up troponin released by skeletal muscle injury. This retrospective observational study was performed investigating troponin assays and how they relate to patient's outcomes. The troponin assays used in this Miami hospital where the database of patients was collected between 2018 and 2023 were troponin I (cTnI), the conventional troponin assay, and the newer high-sensitivity troponin I assay (hs-cTn). In this observational study patients who received an admitting diagnosis of NSTEMI corroborated by an independent cardiologist had their respective troponin assay levels included. Patients found to have ECG changes significant for non-ischemic pathologies, or echocardiogram findings suggestive of myocardial dysfunction not clinically correlated to an ACS were excluded from the study. A total of 75 patients were included in this study and the mean age was 75.97 ±14.72 years, with a presentation of chest pain, dyspnea and general weakness recorded in 59% (n = 45) of patients. The median time between troponin samples was 6.63 hours across both assays and hs-cTn showed a 4.99% increase in variation between samples while cTnI had a decrease of 2.53%. The study objective is to support whether there is a difference in rates of cardiac catheterization or mortality based on the type of troponin testing. There was no significant association found between, the type of troponin assay used during hospital admission, and the outcomes of catheterization and death (p > 0.009).
非ST段抬高型心肌梗死（NSTEMI）是一种急性冠状动脉综合征事件，存在心肌缺血，心肌肌钙蛋白升高而ST段无抬高。用于诊断或排除急性冠状动脉综合征（ACS）的一项基本措施是血液中的肌钙蛋白水平。肌钙蛋白是用于肌肉收缩调节蛋白类别的一个宽泛术语，在ACS评估期间通常会进行检测。肌钙蛋白I仅由心脏组织释放，而一些检测方法也会检测到骨骼肌损伤释放的肌钙蛋白。本回顾性观察性研究旨在调查肌钙蛋白检测方法及其与患者预后的关系。在这家迈阿密医院收集2018年至2023年患者数据库期间使用的肌钙蛋白检测方法为肌钙蛋白I（cTnI），即传统的肌钙蛋白检测方法，以及更新的高敏肌钙蛋白I检测方法（hs-cTn）。在这项观察性研究中，经独立心脏病专家证实入院诊断为NSTEMI的患者纳入了各自的肌钙蛋白检测水平。发现有对非缺血性病变有显著意义的心电图改变，或超声心动图结果提示心肌功能障碍且与ACS无临床相关性的患者被排除在研究之外。本研究共纳入75例患者，平均年龄为75.97±14.72岁，59%（n = 45）的患者表现为胸痛、呼吸困难和全身无力。两种检测方法之间肌钙蛋白样本的中位时间为6.63小时，hs-cTn显示样本间变异增加4.99%，而cTnI下降2.53%。研究目的是支持基于肌钙蛋白检测类型的心脏导管插入术发生率或死亡率是否存在差异。在入院期间使用的肌钙蛋白检测类型与导管插入术和死亡结局之间未发现显著关联（p>0.009）。
