- 作者：M. Odette Gore ; MD ; MSCS&lowast ; ; Stephen L. Seliger ; MD ; MS&dagger ; ; Christopher R. deFilippi ; MD&dagger ; ; Vijay Nambi ; MD ; PhD&Dagger ; ; § ; ; Robert H. Christenson ; PhD鈥?/sup> ; Ibrahim A. Hashim ; PhD¶ ; ; Ron C. Hoogeveen ; PhD&Dagger ; ; Colby R. Ayers ; MS&lowast ; ; # ; Wensheng Sun ; MS&Dagger ; ; Darren K. McGuire ; MD ; MHSc&lowast ; ; &lowast ; &lowast ; ; Christie M. Ballantyne ; MD&Dagger ; ; James A. de Lemos ; MD&lowast ; ; &lowast ; &lowast ; ; James.deLemos@UTSouthwestern.edu" class="auth_mail
- 关键词：diagnosis ; myocardial infarction ; population ; troponin
- 刊名：Journal of the American College of Cardiology
- 出版年：15 April, 2014
- 年：2014
- 卷：63
- 期：14
- 页码：1441-1448
- 全文大小：391 K
class="h4">Objectives
The study sought to determine the 99th percentile upper reference limit for the high-sensitivity cardiac troponin T聽assay (hs-cTnT) in 3 large independent cohorts.class="h4">Background
The presently recommended 14 ng/l cut point for the diagnosis of myocardial infarction using the hs-cTnT assay was derived from small studies of presumably healthy individuals, with relatively little phenotypic characterization.
class="h4">Methods
Data were included from 3 well-characterized population-based studies: the Dallas Heart Study (DHS), the Atherosclerosis Risk in Communities (ARIC) Study, and the Cardiovascular Health Study (CHS). Within each cohort, reference subcohorts were defined excluding individuals with recent hospitalization, overt cardiovascular disease, and kidney disease (subcohort 1), and further excluding those with subclinical structural heart disease (subcohort 2). Data were analyzed stratified by age, sex, and race.
class="h4">Results
The 99th percentile values for the hs-cTnT assay in DHS, ARIC, and CHS were 18, 22, and 36 ng/l (subcohort 1) and 14,聽21, and 28 ng/l (subcohort 2), respectively. These differences in 99th percentile values paralleled age differences across cohorts. Analyses within sex/age strata yielded similar results between cohorts. Within each cohort, 99th percentile values increased with age and were higher in men. More than 10% of men 65 to 74 years of age with no cardiovascular disease in our study had cardiac troponin T values above the current myocardial infarction threshold.
class="h4">Conclusions
Use of a uniform 14 ng/l cutoff for the hs-cTnT assay may lead to over-diagnosis of myocardial infarction, particularly in men and the elderly. Clinical validation is needed of new age- and sex-specific cutoff values for this assay.