Clinical implications of the change of cardiac troponin I levels in patients with acute chest pain - An evaluation with respect to the Universal Definition of Myocardial Infarction

被引:41
作者
Eggers, Kai M. [1 ]
Jaffe, Allan S. [3 ]
Venge, Per [2 ]
Lindahl, Bertil [1 ]
机构
[1] Univ Uppsala Hosp, Dept Med Sci, Uppsala, Sweden
[2] Univ Uppsala Hosp, Dept Clin Chem, Uppsala, Sweden
[3] Mayo Clin & Mayo Fdn, Mayo Med Sch, Rochester, MN 55905 USA
关键词
Chest pain; Myocardial infarction; Diagnostic criteria; Troponin kinetics; ACUTE CORONARY SYNDROMES; EARLY-DIAGNOSIS; EUROPEAN-SOCIETY; T ASSAY; RISK; REDEFINITION; IMPRECISION; PREDICTION; CARDIOLOGY; COLLEGE;
D O I
10.1016/j.cca.2010.09.020
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
Background: The Universal Definition of Myocardial Infarction incorporates elevated cardiac troponin levels (>99th percentile) together with a significant rise/fall of troponins as biochemical criterion. We sought to evaluate the clinical implications of the relative change of cardiac troponin I (cTnI) levels with respect to the Universal Definition in patients with acute chest pain. Methods: cTnI (Stratus CS) was measured serially in 454 patients within 24 h from admission. Acute myocardial infarction (AMI) was defined using the criteria adapted to the ESC/ACC consensus document, or corresponding to the Universal Definition together with prespecified cTnI changes of >= 20%, >= 50% and >= 100%. Follow-up was completed after 5.8 years. Results: A peak cTnI level above the 99th percentile together with a cTnI change of >= 20% was found in 160 patients of whom 25 did not have AMI according to the ESC/ACC criteria. These 160 patients had a significantly raised mortality (HR 2.5[95% CI 1.7-3.8]). Higher cTnI deltas were not associated with higher mortalities but identified smaller patient cohorts at risk. Conclusions: The Universal Definition of AMI together with a >= 20% cTnI change appears to improve the discrimination of acute from chronic causes of cTnI release, and allows a reliable identification of patients at risk. (C) 2010 Elsevier B.V. All rights reserved.
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收藏
页码:91 / 97
页数:7
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