Department of Internal and Emergency Medicine, Trelleborg Hospital, Trelleborg, Sweden.
Department of Cardiology, Lund University, Skåne University Hospital, Entrégatan 7, Lund, 221 85, Sweden.
BMC Cardiovasc Disord. 2024 Oct 12;24(1):551. doi: 10.1186/s12872-024-04230-1.
Troponin elevation is frequently observed in various scenarios in the Emergency Department (ED), yet there is a paucity of studies investigating simultaneously measured high-sensitivity cardiac troponin T (hs-cTnT) and troponin I (hs-cTnI) within a diverse cohort in a clinical setting.
All patients who underwent troponin testing at a single center were eligible for this study. Only patients with simultaneous samples with hs-cTnI (Siemens) and hs-cTnT (Roche) were included, regardless of chief complaint.
Analysis of 1987 samples from 1134 patients showed a significant correlation between hs-cTnT and hs-cTnI (r = 0.86, p < 0.01). Of these samples, 65% exceeded the upper reference limit (URL) for hs-cTnT, and 30% for hs-cTnI with 39% who exhibited elevated hs-cTnT levels alongside normal hs-cTnI levels. The area under the curve (AUC) for acute myocardial infarction (AMI) for the index visit was 0.80 (95% CI; 0.75-0.85) for hs-cTnT and 0.87 (95% CI; 0.83-0.91) for hs-cTnI. Sensitivity and specificity were 91% and 39% for hs-cTnT, and 80% and 80% for hs-cTnI. Positive predictive value (PPV) and negative predictive value (NPV) was 9.3% and 98.5% for hs-cTnT respectively, corresponding for hs-cTnI was 21.3% and 98.3% respectively. Hazard ratios for 1-year mortality were 1.52 (95% CI; 1.40-1.66) for hs-cTnT and 1.26 (95% CI; 1.18-1.34) for hs-cTnI.
Elevated troponins above the URL were very common in this diverse cohort, particularly for hs-cTnT, which was twice as frequent compared to hs-cTnI, resulting in low specificity and PPV for AMI.
在急诊科（ED）的各种情况下经常观察到肌钙蛋白升高，但在临床环境中，同时测量高敏肌钙蛋白 T（hs-cTnT）和肌钙蛋白 I（hs-cTnI）的研究很少。
本研究纳入了在单一中心接受肌钙蛋白检测的所有患者。仅纳入同时有 hs-cTnI（西门子）和 hs-cTnT（罗氏）样本的患者，无论主诉如何。
对 1134 例患者的 1987 个样本进行分析显示，hs-cTnT 和 hs-cTnI 之间存在显著相关性（r=0.86，p<0.01）。这些样本中，65%的 hs-cTnT 超过了 hs-cTnT 的上限参考值（URL），30%的 hs-cTnI 超过了 URL，39%的患者 hs-cTnT 水平升高，hs-cTnI 水平正常。就诊时急性心肌梗死（AMI）的曲线下面积（AUC）为 hs-cTnT 的 0.80（95%CI：0.75-0.85）和 hs-cTnI 的 0.87（95%CI：0.83-0.91）。hs-cTnT 的敏感性和特异性分别为 91%和 39%，hs-cTnI 的敏感性和特异性分别为 80%和 80%。hs-cTnT 的阳性预测值（PPV）和阴性预测值（NPV）分别为 9.3%和 98.5%，hs-cTnI 的相应值分别为 21.3%和 98.3%。hs-cTnT 与 1 年死亡率的危险比为 1.52（95%CI：1.40-1.66），hs-cTnI 的危险比为 1.26（95%CI：1.18-1.34）。
在这个多样化的队列中，hs-cTnT 非常常见，超过 URL 的升高的肌钙蛋白非常常见，尤其是 hs-cTnT，其频率是 hs-cTnI 的两倍，导致 AMI 的特异性和 PPV 较低。
