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

被引：38

作者：

Cullen, Louise ^{[1
,2
]}

Aldous, Sally ^{[3
]}

Than, Martin ^{[3
]}

Greenslade, Jaimi H. ^{[1
,2
,4
]}

Tate, Jillian R. ^{[1
]}

George, PeterM. ^{[3
]}

Hammett, Christopher J. ^{[1
,4
]}

Richards, A. Mark ^{[5
,6
]}

Ungerer, Jacobus P. J. ^{[1
]}

Troughton, Richard W. ^{[5
]}

Brown, Anthony F. T. ^{[1
,4
]}

Flaws, Dylan F. ^{[4
]}

Lamanna, Arvin ^{[1
,4
]}

Pemberton, Christopher J. ^{[5
]}

Florkowski, Christopher ^{[3
]}

Pretorius, Carel J. ^{[1
]}

Chu, Kevin ^{[1
,4
]}

Parsonage, William A. ^{[1
,4
]}

机构：

[1] Royal Brisbane & Womens Hosp, Herston, Qld 4029, Australia

[2] Queensland Univ Technol, Brisbane, Qld 4001, Australia

[3] Christchurch Hosp, Christchurch, New Zealand

[4] Univ Queensland, Brisbane, Qld, Australia

[5] Univ Otago, Christchurch Heart Inst, Christchurch, New Zealand

[6] Natl Univ Heart Ctr, Cardiovasc Res Inst, Singapore, Singapore

来源：

CLINICAL BIOCHEMISTRY | 2014年 / 47卷 / 06期

关键词：

High sensitivity troponin; Acute myocardial infarction; Chest pain; Emergency; Diagnostic accuracy; ACUTE CORONARY SYNDROME; CARDIAC TROPONIN; ABSOLUTE; OUTLIERS; OUTCOMES; UTILITY;

D O I：

10.1016/j.clinbiochem.2013.11.019

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：

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 >= 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. (C) 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

引用

页码：321 / 326

页数：6

共 26 条

[1] Diagnostic and prognostic utility of early measurement with high-sensitivity troponin T assay in patients presenting with chest pain [J].