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| The predictive value of high-sensitive troponin I in acute myocardial infarction of patients with emergency chest pain |
| HAN Min SHEN Qing SHAO Zhoujun SUN Yanni GUO Ruimin▲ |
| Emergency Medicine, Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China |
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Abstract Objective To provide an effective predictive tool in patients with acute myocardial infarction (AMI) via exploring the dynamic changes of the high-sensitive troponin I (hs-cTnI) at different time points, and to identify the range of changes at different diagnostic cut-off point. Methods A total of 142 chest paining patients in Putuo Hospital Affiliated to Shanghai Traditional Chinese Medicine University were collected from November 2016 to December 2017. Seventy-five AMI patients and 37 unstable angina (UA) patients were finally diagnosed. Thirty healthy subjects who underwent physical examination in the same period were selected as the healthy control group. Serum levels of hs-cTnI were measured at admission to hospital (T0) and 3 hours later (T3) by direct chemiluminescence immunoassay. The absolute change value of hs-cTnI and slop coefficient of hs-cTnI (△hs-cTnI) were calculated based on the two time points. The receiver operating characteristic curve (ROC) and Youden index were determined to provide the best diagnostic cut-off point and the optimal ranges. Results ① If chest pain symptoms were improved significantly, (T0) hs-cTnI≥0.04 ng/mL, (T3) hs-cTnI≥0.48 ng/mL [AUC: 0.994, the cutoff: 0.48 ng/mL] or T3-T0 hs-cTnI absolute changes≥0.45 ng/mL [AUC: 0.952, the cutoff: 0.45 ng/mL] were valuable to diagnosis of AMI. ② If chest pain symptoms were persisted, the absolute changes T3-T0 hs-cTnI≥1.001 ng/mL [AUC: 0.945, the cutoff: 1.001 ng/mL] were valuable to diagnosis of AMI. ③ If chest pain transiently occurred, (T0) hs-cTnI≥0.05 ng/mL [AUC: 0.483, the cutoff: 0.05 ng/mL], and the absolute changes hs-cTnI falling≥0.015 ng/mL [AUC: 0.686, the cutoff: -0.015 ng/mL] were valuable to diagnosis of UA. ④△hs-cTnI in the AMI group increased significantly compared with the UA group (P < 0.01). Conclusion AMI can not be effectively diagnosed by hs-cTnI of T0 or T3. The △hs-cTnI single point diagnostic values (T0 or T3) combined with the absolute changes of hs-cTnI are valuable for AMI diagnosis.
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