癌症患者高敏肌钙蛋白T和I的ESC-0/1-h算法的推导与验证
Derivation and Validation of ESC-0/1-h Algorithm for High-Sensitivity Troponin T and I in Cancer Patients.
作者信息
Bima Paolo, Lopez-Ayala Pedro, Koechlin Luca, Morello Fulvio, Boeddinghaus Jasper, Dimitrova Mihaela, Spagnuolo Carlos C, Kaplan Emel, Nestelberger Thomas, Glaeser Jonas, Wildi Karin, du Fay de Lavallaz Jeanne, Morawiec Beata, Miro Oscar, Martínez-Nadal Gemma, Martin-Sanchez Francisco J, Christ Michael, Slankamenac Ksenija, Labarile Giulia, Lindahl Bertil, Giannitsis Evangelos, Lupia Enrico, Mueller Christian
机构信息
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy; Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy.
出版信息
JACC Adv. 2025 Jun;4(6 Pt 1):101821. doi: 10.1016/j.jacadv.2025.101821. Epub 2025 May 22.
BACKGROUND
The diagnostic performance of high-sensitivity cardiac troponin T/I (hs-cTnT/I) and the efficacy of the European Society of Cardiology (ESC) 0/1-h hs-cTnT/I algorithms for the early diagnosis of non-ST-elevation myocardial infarction are lower in cancer patients.
OBJECTIVES
The authors aimed to derive new cutoffs for ESC 0/1-h hs-cTnT/I algorithms optimized for use in patients with active or past cancer.
METHODS
Patients presenting with suspected non-ST-elevation myocardial infarction to the emergency department enrolled in an international multicenter study were analyzed. Final diagnoses were centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction. External validation was performed in 2 independent cohorts.
RESULTS
Among 541 eligible cancer patients, cancer-optimized ESC 0/1-h hs-cTnT cutoffs, <8 ng/L at presentation (if chest pain onset >3 hours) or <14 ng/L if 0/1 h-delta is <3 ng/L for rule-out and ≥54 ng/L or 0/1-h delta ≥4 ng/L for rule-in, increased the efficacy vs the current cutoffs from 58.6% (95% CI: 54.4-62.7) to 68.0% (95% CI: 64.0-71.8; P < 0.001). Sensitivity and specificity remained high and comparable. Similarly, among 516 eligible patients, cancer-optimized ESC 0/1-h hs-cTnI-Architect cutoffs, <7 ng/L at presentation (if chest pain onset >3 hours) or <10 ng/L if 0/1-h delta is <3 ng/L for rule-out and ≥61 ng/L or 0/1-h delta ≥5 ng/L for rule-in, increased the efficacy vs the current cutoffs from 59.3% (95% CI: 55.0-63.5) to 78.9% (95% CI: 75.2-82.2; P < 0.001). Sensitivity and specificity again remained high and comparable. Findings were confirmed in internal and external validation cohorts (n = 130 and n = 195 patients, respectively).
CONCLUSIONS
Cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs increased efficacy maintaining high safety.
背景
在癌症患者中，高敏心肌肌钙蛋白T/I（hs-cTnT/I）的诊断性能以及欧洲心脏病学会（ESC）0/1小时hs-cTnT/I算法对非ST段抬高型心肌梗死的早期诊断效果较低。
目的
作者旨在得出针对正在患癌或既往患癌患者优化的ESC 0/1小时hs-cTnT/I算法的新临界值。
方法
对参加一项国际多中心研究的、因疑似非ST段抬高型心肌梗死就诊于急诊科的患者进行分析。最终诊断由2名独立心脏病专家根据心肌梗死的第四个通用定义进行集中判定。在2个独立队列中进行外部验证。
结果
在541例符合条件的癌症患者中，针对癌症优化的ESC 0/1小时hs-cTnT临界值，就诊时<8 ng/L（如果胸痛发作>3小时），或者如果0/1小时差值<3 ng/L则<14 ng/L用于排除，≥54 ng/L或0/1小时差值≥4 ng/L用于纳入，与当前临界值相比，诊断效果从58.6%（95%CI：54.4 - 62.7）提高到68.0%（95%CI：64.0 - 71.8；P<0.001）。敏感性和特异性仍然很高且相当。同样，在516例符合条件的患者中，针对癌症优化的ESC 0/1小时hs-cTnI-Architect临界值，就诊时<7 ng/L（如果胸痛发作>3小时），或者如果0/1小时差值<3 ng/L则<10 ng/L用于排除，≥61 ng/L或0/1小时差值≥5 ng/L用于纳入，与当前临界值相比，诊断效果从59.3%（95%CI：55.0 - 63.5）提高到78.9%（95%CI：75.2 - 82.2；P<0.001）。敏感性和特异性再次保持在较高水平且相当。研究结果在内部和外部验证队列（分别为n = 130例和n = 195例患者）中得到证实。
结论
针对癌症优化的ESC 0/1小时hs-cTnT/I算法临界值提高了诊断效果，同时保持了高安全性。
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