PDF(Pubmed)
Abstract：
Non-ST segment elevation myocardial infarction (NSTEMI) is an acute coronary syndrome event where myocardial ischemia is present, with an increase of cardiac troponins without an elevation of the ST segment. One of the fundamental measures used to diagnose or rule out acute coronary syndrome (ACS) is troponin levels in the blood. Troponin is a broad term used for the category of muscle contraction regulatory proteins and is commonly measured during ACS evaluation. Troponin I is only released by cardiac tissue, while some assay measurements will also pick up troponin released by skeletal muscle injury. This retrospective observational study was performed investigating troponin assays and how they relate to patient\'s outcomes. The troponin assays used in this Miami hospital where the database of patients was collected between 2018 and 2023 were troponin I (cTnI), the conventional troponin assay, and the newer high-sensitivity troponin I assay (hs-cTn). In this observational study patients who received an admitting diagnosis of NSTEMI corroborated by an independent cardiologist had their respective troponin assay levels included. Patients found to have ECG changes significant for non-ischemic pathologies, or echocardiogram findings suggestive of myocardial dysfunction not clinically correlated to an ACS were excluded from the study. A total of 75 patients were included in this study and the mean age was 75.97 ±14.72 years, with a presentation of chest pain, dyspnea and general weakness recorded in 59% (n = 45) of patients. The median time between troponin samples was 6.63 hours across both assays and hs-cTn showed a 4.99% increase in variation between samples while cTnI had a decrease of 2.53%. The study objective is to support whether there is a difference in rates of cardiac catheterization or mortality based on the type of troponin testing. There was no significant association found between, the type of troponin assay used during hospital admission, and the outcomes of catheterization and death (p > 0.009).
摘要：
非ST段抬高型心肌梗死（NSTEMI）是一种急性冠脉综合征，存在心肌缺血，随着心肌肌钙蛋白的增加，而ST段没有升高。用于诊断或排除急性冠状动脉综合征（ACS）的基本措施之一是血液中的肌钙蛋白水平。肌钙蛋白是用于肌肉收缩调节蛋白类别的广义术语,并且通常在ACS评估期间测量。肌钙蛋白I仅由心脏组织释放,而一些分析测量也会拾取骨骼肌损伤释放的肌钙蛋白。这项回顾性观察研究调查了肌钙蛋白测定及其与患者预后的关系。这家迈阿密医院在2018年至2023年之间收集的患者数据库中使用的肌钙蛋白测定法是肌钙蛋白I（cTnI），常规的肌钙蛋白测定，和较新的高灵敏度肌钙蛋白I测定(hs-cTn)。在这项观察性研究中，接受独立心脏病专家证实的NSTEMI确诊的患者各自的肌钙蛋白测定水平包括在内。发现非缺血性病变的心电图改变明显的患者，本研究排除了提示与ACS无临床相关性的心肌功能障碍或超声心动图检查结果.本研究共纳入75例患者，平均年龄为75.97±14.72岁，出现胸痛，59%(n=45)的患者记录到呼吸困难和全身无力。在两种测定中,肌钙蛋白样品之间的中值时间为6.63小时,并且hs-cTn显示样品之间的变异增加4.99%,而cTnI降低2.53%。研究目的是支持基于肌钙蛋白测试类型的心导管插入率或死亡率是否存在差异。之间没有发现明显的关联，住院期间使用的肌钙蛋白测定的类型，以及导管插入和死亡的结果(p>0.009)。
