新型高敏感肌鈣蛋白T測試提升急性冠狀動脈綜合症的診斷與預後能力

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一項研究表明，新型高敏感肌鈣蛋白T（hsTnT）測試在急性冠狀動脈綜合症（ACS）患者中的診斷和預後能力優於傳統測試。hsTnT在症狀初期即可提供準確診斷，並具有獨立的預測死亡風險的能力，建議在臨床常規中實施這一新測試。

Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome

新型高敏感性肌鈣蛋白 T 測試在急性冠狀動脈綜合症患者中的診斷和預後性能有所提升。

Weber M, Bazzino O, Navarro Estrada JL, et al. Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome. Am Heart J. 2011;162(1):81-88. doi:10.1016/j.ahj.2011.04.007

https://pubmed.ncbi.nlm.nih.gov/21742093/#:~:text=Conclusion%3A%20Troponin%20T%20measured%20with,standard%20test%20in%20clinical%20routine.

Abstract

In the present study, we aimed to analyze the diagnostic and prognostic potential of a newly developed high-sensitive troponin T assay and compared these results with those of a contemporary troponin T assay in 2 distinct patient cohorts, one including patients with evident ACS and the other one including patients with general chest pain.

For this study, we analyzed data from 2 independent patient cohorts, the Bad Nauheim ACS registry and the Prognosis in Acute Coronary Syndromes registry, with a total of 2,506 patients. On admission, clinical data have been recorded, and a single measurement of troponin T has been performed with a contemporary assay (TnT) and a new high-sensitive troponin T assay (hsTnT). Clinical follow-up has been obtained after 6 months. The diagnostic value of hsTnT was superior to TnT (area under the receiver operating characteristic curve 0.949 vs 0.929, P = .016). Specifically, in TnT-negative patients, hsTnT provided strong diagnostic information (area under the receiver operating characteristic curve of 0.81, P < .001). Furthermore, hsTnT provided independent prognostic power for mortality within 6 months in both cohorts, which was superior to that of the contemporary TnT assay.

Troponin T measured with a newly developed hsTnT provides better diagnostic and prognostic information and, therefore, should be implemented as a standard test in clinical routine.

摘要

本研究旨在分析新開發的高敏感性肌鈣蛋白 T 測試的診斷和預後潛力，並將其結果與現代肌鈣蛋白 T 測試進行比較，涉及兩個患者群體：一個是明顯急性冠狀動脈綜合症（ACS）患者，另一個是一般胸痛患者。

本研究分析了來自兩個獨立患者群體的數據，共 2,506 名患者。在入院時記錄臨床數據，並分別使用現代測試（TnT）和新型高敏感性測試（hsTnT）進行單次肌鈣蛋白 T 測量。6 個月後進行臨床隨訪。hsTnT 的診斷價值優於 TnT，且在 TnT 陰性患者中，hsTnT 提供了強有力的診斷信息。此外，hsTnT 在預測 6 個月內死亡率方面具有獨立預後能力，且優於現代 TnT 測試。

使用新開發的 hsTnT 測量的肌鈣蛋白 T 提供了更好的診斷和預後信息，因此應在臨床常規中作為標準測試實施。

章節摘錄

心肌梗塞是冠狀動脈疾病的急性且致命的臨床表現，是發達國家死亡的主要原因。即時診斷、風險分層和特定療法的啟動對於改善懷疑急性冠狀動脈綜合症（ACS）患者的臨床結果至關重要。

我們分析了來自 Bad Nauheim ACS 登記處和急性冠狀動脈綜合症預後（PACS）登記處的兩個獨立患者群體的數據，共 2,506 名患者。這兩個群體不同，前者為確診的高風險 ACS 群體，後者為低風險胸痛群體。

總共分析了 2,506 名患者，1,023 名來自 Bad Nauheim ACS 登記處，1,483 名來自 PACS 登記處。兩個群體在性別、年齡和常規風險因素方面的特徵相似，但在 PACS 群體中，心肌梗塞的診斷和 TnT 或 hsTnT 升高的情況較少。

本研究的主要發現包括：使用 hsTnT 測試的 TnT 診斷準確性提高，特別是在症狀發作後早期呈現的患者中；高敏感性肌鈣蛋白測試在現代測試中 TnT 陰性患者中的診斷準確性高；高敏感性測試的預後價值增加，允許對 TnT 水平陰性的患者進行更好的風險分層。

使用新開發的高敏感性肌鈣蛋白 T 測試測量的肌鈣蛋白 T 在診斷急性心肌梗塞方面提供了更好的診斷信息，尤其是在症狀發作後早期。此外，高敏感性肌鈣蛋白測試的預後信息優於現代肌鈣蛋白測試。將這一新測試實施到臨床常規中，將允許更早且改進的決策。

參考文獻

C. Heeschen et al.
Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. PRISM study investigators. Platelet receptor inhibition in ischemic syndrome management
Lancet
(1999)
J.L. Anderson et al.
ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 2002 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine
J Am Coll Cardiol
(2007)
K. Thygesen et al.
Universal definition of myocardial infarction
J Am Coll Cardiol
(2007)
M. Weber et al.
N-terminal B-type natriuretic peptide assessment provides incremental prognostic information in patients with acute coronary syndromes and normal troponin t values upon admission
J Am Coll Cardiol
(2008)
M. Bonaca et al.
Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I
J Am Coll Cardiol
(2010)
E.W. Nawar et al.
National hospital ambulatory medical care survey: 2005 emergency department summary
Adv Data
(2007)
C.W. Hamm et al.
Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I
N Engl J Med
(1997)
C.W. Hamm et al.
Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. C7e3 fab antiplatelet therapy in unstable refractory angina (capture) study investigators
N Engl J Med
(1999)
J.P. Bassand et al.
Guidelines for the diagnosis and treatment of non–ST-segment elevation acute coronary syndromes
Eur Heart J
(2007)