High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain

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• 作者：Kai M. Eggers^a ; ^{kai.eggers@ucr.uu.se} ; Per Venge^b ; Bertil Lindahl^a ; ^c
• 关键词：cTn ; Cardiac troponin ; CI ; Confidence interval ; CV ; Coefficient of variation ; FAST ; Fast Assessment of Thoracic Pain ; FASTER ; Fast Assessment of Thoracic Pain by nEuRal networks ; H-FABP ; Heart-type fatty-acid binding protein ; Hs ; Highly sensitive ; non-STE
• 刊名：Clinica Chimica Acta
• 出版年：2012
• 期刊代码：54_00098981
• 类别：med
• 出版时间：11 July, 2012
• 卷：413
• 期：13-14
• 页码：1135-1140
• 文件大小：315 K

摘要

Background

Measurement of high-sensitive cardiac troponin (hs-cTn) has facilitated the early diagnostic assessment of chest pain patients. However, the information obtained from hs-cTnT levels might be improved when combined with results of other biomarkers of myocardial injury.

Methods

We measured admission levels of hs-cTnT (Roche Diagnostics), heart-type fatty-acid binding protein (H-FABP; Randox Laboratories) and copeptin using a novel ultra-sensitive (us) assay (Thermo Fisher Scientific) in 360 chest pain patients with a non-diagnostic ECG. Non-STEMI was defined according to the Universal Definition using cardiac troponin I (Stratus CS; Siemens Healthcare Diagnostics) as biochemical gold standard.

Results

Non-STEMI was diagnosed in 128 (36%) patients. Hs-cTnT had a greater diagnostic accuracy regarding non-STEMI (C-statistics 0.84) compared to H-FABP (C-statistics 0.80; p = 0.04) and us-copeptin C-statistics(0.62; p < 0.001). Compared to hs-cTnT alone, no increase in the C-statistics was noted for the combination of hs-cTnT with H-FABP (0.85; p = 0.43) or with us-copeptin (0.84; p = 0.88). Due to suboptimal sensitivities and/or specificities, neither H-FABP nor us-copeptin dichotomized at commonly applied diagnostic thresholds added information to hs-cTnT that would have facilitated early diagnostic assessment.

Conclusions

Hs-cTnT provides an excellent early diagnostic accuracy regarding non-STEMI already on admission. Neither H-FABP nor us-copeptin perform better or provide diagnostic increment to hs-cTnT levels.