Is high-sensitivity troponin as good as you think?


The important role of cardiac troponin (cTn) in the diagnosis high sensitive troponin i and prognosis of myocardial injury has become increasingly prominent. Generally speaking, cTn needs 4 to 6 hours after myocardial injury to continue to show a significant increase in the problem. This has made many countries in my country have begun to have patients with acute coronary syndrome (ACS) symptoms because we are in China. It is misdiagnosed due to the window period of traditional inspection and analysis methods.

However, with the development of technology, the detection of high-sensitivity troponin (hs-ctn) has greatly improved the sensitivity and analytical accuracy of traditional methods, shortened the diagnosis time, and can even produce results within 1 hour, making it suitable for clinical practice The application in the industry is becoming more and more extensive. A Canadian study showed that the hs-tnt test has an accuracy rate of 76% in identifying myocardial infarction (ami) within one hour.

We have always believed that the sooner ACS is diagnosed and the earlier intervention, the better the prognosis for the patient. However, a recent study published in the Circulation sub-Journal Circulation: Cardiovascular Quality and Outcomes shows that compared with traditional methods, hs-TnT may not be as good as everyone thinks for the diagnosis of acute chest pain.

The effect of Hs-TnT on improving the prognosis of patients

From July 2011 to March 2013, the Australian research team randomly divided 1937 emergency patients without ST-segment elevation myocardial infarction (STEMI) into two groups, and performed the traditional TNT test (964 cases, positive standard cTnT) ≥ 30ng/L) and HS-TNT test (973, positive standard cTnT>3ng/L), and then followed up for one year to evaluate the all-cause mortality and new-onset and recurrence rates of ACS.

The results showed that there was no significant difference between the traditional method and the hs-tnt method in the one-year all-cause mortality rate and the recurrence rate of new-onset acute coronary syndromes (9.7% vs 7.2%, p = 0.362). The results may be disappointing, but for patients with a tnt content of less than 30ng/l, the hs-tnt method does slightly reduce the mortality rate (2.6% vs 4.4%, p = 0.05).

High-sensitivity troponin is really as good as you think?

Compared with the traditional method, the hs-tnt method can significantly increase the 24-hour ctnt peak value of 15-29ng/l in aspirin prescription (55.4% vs 34.0%, p = 0.006).

At present, the routine application of HS-TNT has become the mainstream recommendation for the diagnosis and treatment of ACS, especially for the judgment of early discharged patients. However, the researchers also pointed out that this study emphasizes that new diagnoses and treatments should not receive too much respect. HS-TNT can indeed greatly improve the accuracy of diagnosis, but it does not significantly improve the effect and efficiency of treatment and care, especially for patients with low or even negative TNT levels.

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