Saeed Nasir, Steiro Ole-Thomas, Langørgen Jørund, Tjora Hilde L, Bjørneklett Rune O, Skadberg Øyvind, Bonarjee Vernon V S, Mjelva Øistein R, Norekvål Tone M, Steinsvik Trude, Vikenes Kjell, Omland Torbjørn, Aakre Kristin M
Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Clin Chem. 2024 Oct 3;70(10):1241-1255. doi: 10.1093/clinchem/hvae110.
There are limited data regarding the utility of follow-up cardiac troponin (cTn) measurements after admission for acute chest pain and how long-term stability of myocardial injury and prognostic value differ when using cardiac troponin T (cTnT) or I (cTnI).
We measured high-sensitivity (hs)-cTnT (Roche Diagnostics) and hs-cTnI (Siemens Healthineers) during hospitalization for acute chest pain and after 3 months. Acute myocardial injury was defined as concentrations > sex-specific upper reference limit (URL) during hospitalization and ≤URL at 3-months. Chronic myocardial injury (CMI) was defined as concentrations > URL at both time points. Patients were followed from the 3-month sampling point for a median of 1586 (IQR 1161-1786) days for a primary composite endpoint of all-cause mortality, myocardial infarction (MI), revascularization, and heart failure, and a secondary endpoint of all-cause mortality.
Among 754 patients, 33.8% (hs-cTnT) and 19.2% (hs-cTnI) had myocardial injury during hospitalization. The rate of CMI was 5 times higher by hs-cTnT (20%) assay than hs-cTnI (4%), while acute myocardial injury was equally common; 14% (hs-cTnT) and 15% (hs-cTnI), respectively (6% and 5% when excluding index non-ST-elevation MI (NSTEMI). For hs-cTnT, peak index concentration, 3-month concentration and classification of CMI predicted the primary endpoint; hazard ratios (HRs) 1.38 (95% CI 1.20-1.58), 2.34 (1.70-3.20), and 2.31 (1.30-4.12), respectively. For hs-cTnI, peak index concentration predicted the primary endpoint; HR 1.14 (1.03-1.25). This association was nonsignificant after excluding index NSTEMI.
Acute myocardial injury is equally frequent, whereas CMI is more prevalent using hs-cTnT assay than hs-cTnI. Measuring hs-cTnT 3 months after an acute chest pain episode could assist in further long-term risk assessment. ClinicalTrials.gov Registration Number: NCT02620202.
关于急性胸痛入院后随访心肌肌钙蛋白（cTn）测量的效用，以及使用心肌肌钙蛋白T（cTnT）或I（cTnI）时心肌损伤的长期稳定性和预后价值如何不同，相关数据有限。
我们在急性胸痛住院期间及3个月后测量了高敏（hs）-cTnT（罗氏诊断）和hs-cTnI（西门子医疗）。急性心肌损伤定义为住院期间浓度>性别特异性上限参考值（URL）且3个月时≤URL。慢性心肌损伤（CMI）定义为两个时间点的浓度均>URL。从3个月采样点开始对患者进行随访，中位随访时间为1586（四分位间距1161 - 1786）天，观察全因死亡、心肌梗死（MI）、血运重建和心力衰竭的主要复合终点，以及全因死亡的次要终点。
在754例患者中，33.8%（hs-cTnT）和19.2%（hs-cTnI）在住院期间发生心肌损伤。hs-cTnT检测的CMI发生率（20%）比hs-cTnI检测（4%）高5倍，而急性心肌损伤同样常见；分别为14%（hs-cTnT）和15%（hs-cTnI）（排除首次非ST段抬高型心肌梗死（NSTEMI）时为6%和5%）。对于hs-cTnT，峰值指数浓度、3个月浓度和CMI分类可预测主要终点；风险比（HR）分别为1.38（95%CI 1.20 - 1.58）、
