High-sensitive Troponin I in acute cardiac conditions: Implications of baseline and sequential measurements for diagnosis of myocardial infarction

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• 作者：Tobias Gassenmaier^a ; Stefan Buchner^a ; Christoph Birner^a ; Carsten G. Jungbauer^a ; Markus Resch^a ; Kurt Debl^a ; Dierk H. Endemann^a ; Guenter A.J. Riegger^a ; Petra Lehn^b ; Gerd Schmitz^b ; Andreas Luchner^a ; ^{andreas.luchner@klinik.uni-regensburg.de}
• 关键词：hsTnI ; high-sensitive Troponin I ; MI ; Myocardial infarction ; STEMI ; ST-elevation myocardial infarction ; Non-STEMI ; Non-ST-elevation myocardial infarction ; ROC ; Receiver operating characteristics ; AUC ; Area under the curve ; ECG ; Electrocardiography ; MRI ; M
• 刊名：Atherosclerosis
• 出版年：2012
• 期刊代码：28_00219150
• 类别：med
• 出版时间：May, 2012
• 卷：222
• 期：1
• 页码：116-122
• 文件大小：400 K

摘要

Background

High-sensitive Troponin I (hsTnI) facilitates the early diagnosis of myocardial infarction (MI). However, since hsTnI has not been well characterized in non-ischemic cardiac conditions, the predictive value of hsTnI for MI remains unclear.

Methods

hsTnI (ADVIA Centaur, Siemens) on admission was analyzed in 929 patients with acute cardiac condition and invasive ascertainment of coronary status by catheterization.

Results

Hs-TnI upon presentation was higher in patients with STEMI (median 1.27 ng/mL, IQR 0.13-14.5 ng/mL) as compared to patients with Non-STEMI (0.66 ng/mL, IQR 0.10-4.0 ng/mL, p < 0.001) whereas it did not differ from STEMI in Tako-Tsubo cardiomyopathy (2.57 ng/mL, IQR 0.17-8.4 ng/mL) and myocarditis (9.76 ng/mL, IQR 2.0-27.0 ng/mL). In patients with resuscitation of non-ischemic cause (0.31 ng/mL, IQR 0.06-1.3 ng/mL), acute heart failure (0.088 ng/mL, IQR 0.035-0.30 ng/mL) and hypertensive emergency (0.066 ng/mL, IQR 0.032-0.34 ng/mL), hs-TnI was elevated above the recommended threshold of 0.04 ng/mL. At this cutpoint of 0.04 ng/mL, hsTnI indicated acute MI (STEMI or Non-STEMI) with a sensitivity of 88%and a specificity of 45%(ROC-AUC 0.748). When patients with STEMI were excluded, hsTnI indicated Non-STEMI with a sensitivity of 87%and a specificity of 45%(ROC-AUC 0.725). When sequential measurements were taken into account in a restricted cohort, a maximum hsTnI of 鈮?.40 ng/mL provided a sensitivity of 89%and a specificity of 85%(ROC-AUC 0.909) for Non-STEMI.

Conclusions

HsTnI is a sensitive, albeit unspecific marker of MI. In patients with mildly elevated hsTnI and without evidence for STEMI, we suggest serial assessment of hsTnI and a 10-fold higher cutpoint of 0.40 ng/mL before Non-STEMI is assumed.