Comparison of high sensitivity troponin T and I assays in the diagnosis of non-ST elevation acute myocardial infarction in emergency patients with chest pain

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• 作者：Louise Cullen^a ; ^b ; ¹ ; Sally Aldous^c ; ¹ ; Martin Than^c ; Jaimi H. Greenslade^a ; ^b ; ^d ; Jillian R. Tate^a ; Peter M. George^c ; Christopher J. Hammett^a ; ^d ; A. Mark Richards^e ; ^f ; Jacobus P.J. Ungerer^a ; Richard W. Troughton^e ; Anthony F.T. Brown^a ; ^d ; Dylan F. Flaws^d ; Arvin Lamanna^a ; ^d ; Christopher J. Pemberton^e ; Christopher Florkowski^c ; Carel J. Pretorius^a ; Kevin Chu^a ; ^d ; William A. Parsonage^a ; ^d
• 关键词：ACS ; acute coronary syndrome ; AMI ; acute myocardial infarction ; cTn ; cardiac troponin ; ECG ; electrocardiograph ; ED ; emergency department ; hs ; high sensitivity ; NLR ; negative likelihood ratio ; NSTEMI ; non-ST elevation myocardial infarction ; PLR ; positive likelihood ratio ; UAP ; unstable angina pectoris
• 刊名：Clinical Biochemistry
• 出版年：April, 2014
• 年：2014
• 卷：47
• 期：6
• 页码：321-326
• 全文大小：480 K

文摘

Objectives

Concentrations of troponin measured with high sensitivity troponin assays are raised in a number of emergency department (ED) patients; however many are not diagnosed with acute myocardial infarction (AMI). Clinical comparisons between the early use (2 h after presentation) of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) assays for the diagnosis of AMI have not been reported.

Design and methods

Early (0 h and 2 h) hs-cTnT and hs-cTnI assay results in 1571 ED patients with potential acute coronary syndrome (ACS) without ST elevation on electrocardiograph (ECG) were evaluated. The primary outcome was diagnosis of index AMI adjudicated by cardiologists using the local cTnI assay results taken 鈮?#xA0;6 h after presentation, ECGs and clinical information. Stored samples were later analysed with hs-cTnT and hs-cTnI assays.

Results

The ROC analysis for AMI (204 patients; 13.0%) for hs-cTnT and hs-cTnI after 2 h was 0.95 (95% CI: 0.94-0.97) and 0.98 (95% CI: 0.97-0.99) respectively. The sensitivity, specificity, PLR, and NLR of hs-cTnT and hs-cTnI for AMI after 2 h were 94.1% (95% CI: 90.0-96.6) and 95.6% (95% CI: 91.8-97.7), 79.0% (95% CI: 76.8-81.1) and 92.5% (95% CI: 90.9-93.7), 4.48 (95% CI: 4.02-5.00) and 12.86 (95% CI: 10.51-15.31), and 0.07 (95% CI: 0.04-0.13) and 0.05 (95% CI:0.03-0.09) respectively.

Conclusions

Exclusion of AMI 2 h after presentation in emergency patients with possible ACS can be achieved using hs-cTnT or hs-cTnI assays. Significant differences in specificity of these assays are relevant and if using the hs-cTnT assay, further clinical assessment in a larger proportion of patients would be required.