Clinical value of high sensitivity cardiac troponin T in the diagnosis of acute myocardial infarction / 中华检验医学杂志

ABSTRACT

Objective To establish an appropriate cut-off value of high sensitivity cardiac troponin T (hs-cTnT) and optimal combination measurement in the early diagnosis of acute myocardial infarction (AMI).Methods This research is a prospective study.342 patients admitted to emergency department with chest pain,43 patients with renal failure,40 patients with pneumonia and 18 premature with patent ductus arteriosus were involved from June 2012 to June 2013 in Peking University Third Hospital.The plasma hs-TnT,NT-proBNP,cardiac troponin Ⅰ (cTnI),CK-MB and copeptin were measured.The distribution of hs-cTnT among associated diseases was analyzed,the diagnostic performance of hs-cTnT and the role of combination hs-cTnT with NT-proBNP,CK-MB and copeptin were evaluated by receiver operating characteristic (ROC) curve.The statistical method was used to calculate the Sensitivity,specificity,negative predictive value and positive predictive value of hs-cTnT in the diagnosis of AMI.Results As compared to patients with STEMI(median 0.52 μg/L,range 0.037-7.610 μg/L),hs-cTnT was lower in the patients with Non-STEMI(median 0.127 5 μg/L,range 0.021-4.260 μg/L).However,the levels of hs-TnT in other diseases were also increased increased in varyng degrees (Chi-square =76.432,P ＜ 0.05)The areas under the curve (AUC) for hs-cTnT and cTnI in the diagnosis of AMI were 0.862 (95％ CI0.729-0.928) and 0.748 (95％ CI0.666-0.818) respectively (Z =2.713,P ＜ 0.05).Taking 0.014μg/L and 0.035 μg/L as cut-off value of hs-TNT,the sensitivities were 100％ vs 95.1％,the specificities were 44.4％ vs 65.7％.The combination of hs-cTnT,NT-proBNP,CK-MB resulted in a increase in AUC (0.915,95％ CI0.838-0.964) (Z =2.147,P ＜ 0.05) and the combination of hs-cTnT and copeptin resulted in a increase in AUC 0.921 (95％ CI0.820-0.975) (Z =2.589,P ＜ 0.05).Conclusion With the cut-off value of 0.035 μg/L for diagnosis of AMI was appropriate,and the combination measurement can improve the accuracy of early diagnosis of AMI.