歐洲一項(xiàng)研究表明,，高敏心肌肌鈣蛋白T（hs-cTnT）預(yù)測遠(yuǎn)期死亡的準(zhǔn)確性優(yōu)于高敏心肌肌鈣蛋白I（hs-cTnI）。論文7月2日在線發(fā)表于《歐洲心臟雜志》（Eur Heart J）,。
此項(xiàng)研究共納入1117例非選擇性急性胸痛患者,，并以設(shè)盲方式同時(shí)采用三種新型方法和一種傳統(tǒng)方法測定心肌肌鈣蛋白,。就死亡狀況對患者進(jìn)行為期2年的隨訪,。隨訪期間共有82例（7.3%）患者死亡。
結(jié)果顯示,，hs-cTnT的2年預(yù)測準(zhǔn)確性最高（AUC 0.78）,，并且優(yōu)于hs-cTnI和心肌肌鈣蛋白T（cTnT）。在預(yù)測死亡率方面方面,，hs-cTnT絕對變化預(yù)測死亡的準(zhǔn)確性優(yōu)于hs-cTnT相對變化,，但不如hs-cTnT現(xiàn)值。6小時(shí)內(nèi)hs-cTnT變化與現(xiàn)值聯(lián)合未能進(jìn)一步改善預(yù)測準(zhǔn)確性,。在既存冠脈疾病,、腎功能受損和年齡>75歲等具有臨床預(yù)測難度的亞組患者中，hs-cTn濃度仍為死亡預(yù)測因素,。（生物谷Bioon.com）
生物谷推薦英文摘要：
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.
