Application of High-Sensitivity Troponin in Suspected Myocardial Infarction

被引：266

作者：

Neumann, J. T. ^{[1
,2
]}

Twerenbold, R. ^{[1
,17
,18
]}

Ojeda, F. ^{[1
]}

Soerensen, N. A. ^{[1
,2
]}

Chapman, A. R. ^{[19
]}

Shah, A. S. V. ^{[19
,20
]}

Anand, A. ^{[19
]}

Boeddinghaus, J. ^{[17
,18
]}

Nestelberger, T. ^{[17
,18
]}

Badertscher, P. ^{[17
,18
]}

Mokhtari, A. ^{[25
]}

Pickering, J. W. ^{[31
,32
]}

Troughton, R. W. ^{[31
,32
]}

Greenslade, J. ^{[33
,35
]}

Parsonage, W. ^{[34
,35
]}

Mueller-Hennessen, M. ^{[4
,5
]}

Gori, T. ^{[6
]}

Jernberg, T. ^{[26
]}

Morris, N. ^{[21
,22
]}

Liebetrau, C. ^{[10
,11
,12
]}

Hamm, C. ^{[10
,11
,12
]}

Katus, H. A. ^{[4
,5
]}

Muenzel, T. ^{[6
]}

Landmesser, U. ^{[13
,14
]}

Salomaa, V. ^{[36
]}

Iacoviello, L. ^{[37
,38
]}

Ferrario, M. M. ^{[38
]}

Giampaoli, S. ^{[39
]}

Kee, F. ^{[23
]}

Thorand, B. ^{[15
]}

Peters, A. ^{[15
,16
]}

Borchini, R. ^{[38
]}

Jorgensen, T. ^{[40
,41
,42
]}

Soederberg, S. ^{[27
,28
]}

Sans, S. ^{[43
]}

Tunstall-Pedoe, H. ^{[24
]}

Kuulasmaa, K. ^{[36
]}

Renne, T. ^{[3
]}

Lackner, K. J. ^{[9
]}

Worster, A. ^{[44
]}

Body, R. ^{[21
,22
]}

Ekelund, U. ^{[25
]}

Kavsak, P. A. ^{[45
]}

Keller, T. ^{[10
,11
]}

Lindahl, B. ^{[29
,30
]}

Wild, P. ^{[7
,8
]}

Giannitsis, E. ^{[4
,5
]}

Than, M. ^{[31
,32
]}

Cullen, L. A. ^{[33
,35
]}

Mills, N. L. ^{[19
,20
]}

机构：

[1] Univ Heart Ctr Hamburg, Hamburg, Germany

[2] German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Hamburg, Germany

[3] Univ Med Ctr Hamburg Eppendorf, Inst Clin Chem & Lab Med, Hamburg, Germany

[4] Heidelberg Univ Hosp, Dept Cardiol, Heidelberg, Germany

[5] DZHK Partner Site Heidelberg Mannheim, Heidelberg, Germany

[6] Johannes Gutenberg Univ Mainz, Cardiol 1, Univ Med Ctr, Mainz, Germany

[7] Johannes Gutenberg Univ Mainz, Ctr Cardiol, Prevent Cardiol & Prevent Med, Univ Med Ctr, Mainz, Germany

[8] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Ctr Thrombosis & Hemostasis, Mainz, Germany

[9] Univ Med Ctr Mainz, Inst Clin Chem & Lab Med, Mainz, Germany

[10] Kerckhoff Heart & Thorax Ctr, DZHK Partner Site Rhine Main, Bad Nauheim, Germany

[11] Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany

[12] Justus Liebig Univ Giessen & Marburg, Dept Cardiol, Giessen, Germany

[13] Charite Univ Med Berlin, Campus Benjamin Franklin, Berlin Inst Hlth, Dept Cardiol, Berlin, Germany

[14] DZHK Partner Site Berlin, Berlin, Germany

[15] German Res Ctr Environm Hlth, Inst Epidemiol, Helmholtz Zentrum, Munich, Germany

[16] DZHK Partner Site Munich Heart Alliance, Munich, Germany

[17] Univ Basel, Univ Hosp Basel, Cardiovasc Res Inst Basel, Basel, Switzerland

[18] Univ Basel, Univ Hosp Basel, Dept Cardiol, Basel, Switzerland

[19] Univ Edinburgh, British Heart Fdn, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland

[20] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Midlothian, Scotland

[21] Univ Manchester, Manchester, Lancs, England

[22] Manchester Univ Fdn Trust, Manchester, Lancs, England

[23] Queens Univ Belfast, Clin Res Collaborat Publ Hlth, Belfast, Antrim, North Ireland

[24] Univ Dundee, Inst Cardiovasc Res, Cardiovasc Epidemiol Unit, Dundee, Scotland

[25] Lund Univ, Skane Univ Hosp, Dept Internal & Emergency Med, Lund, Sweden

[26] Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Stockholm, Sweden

[27] Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden

[28] Umea Univ, Heart Ctr, Cardiol, Umea, Sweden

[29] Uppsala Univ, Dept Med Sci, Uppsala, Sweden

[30] Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden

[31] Univ Otago Christchurch, Dept Med, Christchurch, New Zealand

[32] Christchurch Hosp, Emergency Dept, Christchurch, New Zealand

[33] Royal Brisbane & Womens Hosp, Dept Emergency Med, Herston, Qld, Australia

[34] Royal Brisbane & Womens Hosp, Cardiol, Herston, Qld, Australia

[35] Queensland Univ Technol, Inst Hlth & Biomed Innovat, Kelvin Grove, Australia

[36] Natl Inst Hlth & Welf, Helsinki, Finland

[37] Ist Ricovero & Cura Carattere Sci Neuromed, Dept Epidemiol & Prevent, Pozzilli, Italy

[38] Univ Insubria, Res Ctr Epidemiol & Prevent Med, Dept Med & Surg, Varese, Italy

[39] Natl Inst Hlth, Dept Cardiovasc Dysmetabol & Aging Associated Dis, Rome, Italy

[40] Univ Copenhagen, Fac Hlth & Med Sci, Copenhagen, Denmark

[41] Res Ctr Prevent & Hlth, Glostrup, Denmark

[42] Aalborg Univ, Med Fac, Aalborg, Denmark

[43] Catalan Dept Hlth, Barcelona, Spain

[44] McMaster Univ, Div Emergency Med, Hamilton, ON, Canada

[45] McMaster Univ, Dept Pathol & Mol Med, Hamilton, ON, Canada

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2019年 / 380卷 / 26期

关键词：

CARDIAC TROPONIN; RULE-OUT; EARLY-DIAGNOSIS; I ASSAY; BIOMARKER; POPULATION; VALIDATION; ALGORITHM; OUTCOMES;

D O I：

10.1056/NEJMoa1803377

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BackgroundData regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes. MethodsIn 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days. ResultsAmong 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set. ConclusionsA risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes.

引用

页码：2529 / 2540

页数：12

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