Diagnosing Myocardial Injury in an Acute Chest Pain Cohort; Long-Term Prognostic Implications of Cardiac Troponin T and I

被引：3

作者：

Saeed, Nasir ^{[1
]}

Steiro, Ole-Thomas ^{[2
]}

Langorgen, Jorund ^{[2
]}

Tjora, Hilde L. ^{[3
]}

Bjorneklett, Rune O. ^{[3
,4
]}

Skadberg, Oyvind ^{[5
]}

Bonarjee, Vernon V. S. ^{[6
]}

Mjelva, oistein R. ^{[7
]}

Norekval, Tone M. ^{[1
,2
]}

Steinsvik, Trude ^{[8
,9
]}

Vikenes, Kjell ^{[1
,2
]}

Omland, Torbjorn ^{[10
,11
]}

Aakre, Kristin M. ^{[1
,2
]}

机构：

[1] Univ Bergen, Dept Clin Sci, Bergen, Norway

[2] Haukeland Hosp, Dept Heart Dis, Bergen, Norway

[3] Haukeland Hosp, Emergency Care Clin, Bergen, Norway

[4] Univ Bergen, Dept Clin Med, Bergen, Norway

[5] Stavanger Univ Hosp, Lab Med Biochem, Stavanger, Norway

[6] Stavanger Univ Hosp, Dept Cardiol, Stavanger, Norway

[7] Stavanger Univ Hosp, Dept Med, Stavanger, Norway

[8] Vestre Viken Hosp Trust, Dept Lab Med, Baerum, Norway

[9] Univ Oslo, Inst Clin Med, Oslo, Norway

[10] Univ Oslo, Inst Clin Med, KG Jebsen Ctr Cardiac Biomarkers, Oslo, Norway

[11] Haukeland Hosp, Dept Med Biochem & Pharmacol, Bergen, Norway

来源：

CLINICAL CHEMISTRY | 2024年 / 70卷 / 10期

关键词：

ACUTE CORONARY SYNDROME; GENERAL-POPULATION; UNIVERSAL DEFINITION; MORTALITY; RISK; ASSOCIATIONS; PREDICTION; BIOMARKERS; OUTCOMES; EVENTS;

D O I：

10.1093/clinchem/hvae110

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: There are limited data regarding the utility of follow-up cardiac troponin (cTn) measurements after admission for acute chest pain and how long-term stability of myocardial injury and prognostic value differ when using cardiac troponin T (cTnT) or I (cTnI). Methods: We measured high-sensitivity (hs)-cTnT (Roche Diagnostics) and hs-cTnI (Siemens Healthineers) during hospitalization for acute chest pain and after 3 months. Acute myocardial injury was defined as concentrations > sex-specific upper reference limit (URL) during hospitalization and <= URL at 3-months. Chronic myocardial injury (CMI) was defined as concentrations > URL at both time points. Patients were followed from the 3-month sampling point for a median of 1586 (IQR 1161-1786) days for a primary composite endpoint of all-cause mortality, myocardial infarction (MI), revascularization, and heart failure, and a secondary endpoint of all-cause mortality. Results: Among 754 patients, 33.8% (hs-cTnT) and 19.2% (hs-cTnI) had myocardial injury during hospitalization. The rate of CMI was 5 times higher by hs-cTnT (20%) assay than hs-cTnI (4%), while acute myocardial injury was equally common; 14% (hs-cTnT) and 15% (hs-cTnI), respectively (6% and 5% when excluding index non-ST-elevation MI (NSTEMI). For hs-cTnT, peak index concentration, 3-month concentration and classification of CMI predicted the primary endpoint; hazard ratios (HRs) 1.38 (95% CI 1.20-1.58), 2.34 (1.70-3.20), and 2.31 (1.30-4.12), respectively. For hs-cTnI, peak index concentration predicted the primary endpoint; HR 1.14 (1.03-1.25). This association was nonsignificant after excluding index NSTEMI. Conclusions: Acute myocardial injury is equally frequent, whereas CMI is more prevalent using hs-cTnT assay than hs-cTnI. Measuring hs-cTnT 3 months after an acute chest pain episode could assist in further long-term risk assessment.

引用

页码：1241 / 1255

页数：15