Lee T H, Thomas E J, Ludwig L E, Sacks D B, Johnson P A, Donaldson M C, Cook E F, Pedan A, Kuntz K M, Goldman L
Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Am J Cardiol. 1996 May 15;77(12):1031-6. doi: 10.1016/s0002-9149(96)00126-9.
To assess the diagnostic performance of cardiac troponin T as a marker for myocardial injury in patients undergoing major noncardiac surgery, we prospectively collected preoperative and postoperative clinical data, including measurements for creatine kinase (CK), CK-MB, and troponin T for 1,175 patients undergoing major noncardiac surgery. Acute myocardial infarction was diagnosed in 17 patients (1.4%) by a reviewer who was blinded to troponin T data and who used CK-MB and electrocardiographic criteria to define acute myocardial infarction. Other predischarge major cardiac complications were detected for another 17 patients. Troponin T elevations (>0.1 ng/ml) occurred in 87% of patients with and in 16% of patients without myocardial infarction. Among patients without myocardial infarction, troponin T was elevated in 62% of patients with and in 15% of patients without major cardiac complications. Receiver-operating characteristic analysis indicated that troponin T had a performance for the diagnosis of acute myocardial infarction similar to CK-MB, and a significantly better correlation with other major cardiac complications in patients without definitive infarction. Future research should seek to determine the significance of troponin T elevations in patients without complications.
为评估心肌肌钙蛋白T作为接受非心脏大手术患者心肌损伤标志物的诊断性能，我们前瞻性收集了1175例接受非心脏大手术患者术前和术后的临床数据，包括肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）和肌钙蛋白T的测量值。一名对肌钙蛋白T数据不知情的评审员依据CK-MB和心电图标准诊断出17例患者（1.4%）发生急性心肌梗死。另外还检测到17例患者在出院前出现其他严重心脏并发症。发生心肌梗死的患者中有87%肌钙蛋白T升高（>0.1 ng/ml），未发生心肌梗死的患者中有16%肌钙蛋白T升高。在未发生心肌梗死的患者中，出现严重心脏并发症的患者中有62%肌钙蛋白T升高，未出现严重心脏并发症的患者中有15%肌钙蛋白T升高。受试者工作特征分析表明，肌钙蛋白T诊断急性心肌梗死的性能与CK-MB相似，在未明确发生梗死的患者中，其与其他严重心脏并发症的相关性显著更好。未来的研究应致力于确定无并发症患者肌钙蛋白T升高的意义。
