欧洲一项研究表明，高敏心肌肌钙蛋白T（hs-cTnT）预测远期死亡的准确性优于高敏心肌肌钙蛋白I（hs-cTnI）。论文7月2日在线发表于《欧洲心脏杂志》（Eur Heart J）。
此项研究共纳入1117例非选择性急性胸痛患者，并以设盲方式同时采用三种新型方法和一种传统方法测定心肌肌钙蛋白。就死亡状况对患者进行为期2年的随访。随访期间共有82例（7.3%）患者死亡。
结果显示，hs-cTnT的2年预测准确性最高（AUC 0.78），并且优于hs-cTnI和心肌肌钙蛋白T（cTnT）。在预测死亡率方面方面，hs-cTnT绝对变化预测死亡的准确性优于hs-cTnT相对变化，但不如hs-cTnT现值。6小时内hs-cTnT变化与现值联合未能进一步改善预测准确性。在既存冠脉疾病、肾功能受损和年龄>75岁等具有临床预测难度的亚组患者中，hs-cTn浓度仍为死亡预测因素。（生物谷Bioon.com）
生物谷推荐英文摘要：
Eur Heart J http://eurheartj.oxfordjournals.org
Risk stratification in patients with acute chest painusing three high-sensitivity cardiac troponin assays
Philip Haaf, Tobias Reichlin, Raphael Twerenbold, Rebeca Hoeller,Maria Rubini Gime′ nez, Christa Zellweger, Berit Moehring, Catherine Fischer,Bernadette Meller, Karin Wildi, Michael Freese, Claudia Stelzig,Tamina Mosimann, Miriam Reiter, Mira Mueller, Thomas Hochgruber,Seoung Mann Sou, Karsten Murray, Jan Minners, Heike Freidank, Stefan Osswald and Christian Mueller
Aims Several high-sensitivity cardiac troponin (hs-cTn) assays have recently been developed. It is unknown which hs-cTn pro-vides the most accurate prognostic information and to what extent early changes in hs-cTn predict mortality.
Methods and results In a prospective, international multicentre study, cTn was simultaneously measured with three novel [high-sensitivitycardiac Troponin T (hs-cTnT), Roche Diagnostics; hs-cTnI, Beckman-Coulter; hs-cTnI, Siemens] and a conventional assay (cTnT, Roche Diagnostics) in a blinded fashion in 1117 unselected patients with acute chest pain. Patients were fol-lowed up 2 years regarding mortality. Eighty-two (7.3%) patients died during the follow-up. The 2-year prognostic accur-acy of hs-cTn was most accurate for hs-cTnT [area under the receivers operating characteristic curve (AUC) 0.78 (95%CI: 0.73 – 0.83) and outperformed both hs-cTnI (Beckman-Coulter, 0.71 (95% CI: 0.65 – 0.77; P ? 0.001 for comparison),hs-cTnI (Siemens) 0.70 (95% CI: 0.64 – 0.76; P , 0.001 for comparison)] and cTnT 0.67 (95% CI: 0.61 – 0.74; P , 0.001 forcomparison). Absolute changes of hs-cTnT were more accurate than relative changes in predicting mortality, but inferior to presentation values of hs-cTnT. Combining changes of hs-cTnT within the first 6 h with their presentation values did not further improve prognostic accuracy. Similar results were obtained for both hs-cTnI assays regarding the incremental value of changes. Hs-cTn concentrations remained predictors of death in clinically challenging subgroups such as patients with pre-existing coronary artery disease, impaired renal function, and patients older than 75 years.
Conclusion High-sensitivity cardiac Troponin T is more accurate than hs-cTnI in the prediction of long-term mortality. Changes of hs-cTn do not seem to further improve risk stratification beyond initial presentation values.
