性别特异的hs-cTnT对老年胸痛患者急性心肌梗死的诊断价值

Diagnostic Value of Sex-Specific hs-cTnT for Acute Myocardial Infarction in Elderly Patients with Chest Pain

目的使用性别特异的超敏心肌肌钙蛋白T(hs-cTnT)第99百分位值,评估老年胸痛患者急性心肌梗死(AMI)的诊断价值。方法纳入因胸痛就诊于四川大学华西医院胸痛中心年龄>65岁、心电图无典型ST段升高的可疑AMI患者,收集患者临床资料,分别使用传统的和性别特异的hs-cTnT第99百分位值来评估老年胸痛患者诊断AMI的临床价值。结果共纳入757例符合标准的研究对象,平均年龄75岁,男522例(68.96%),女235例(31.04%)。对符合标准的研究对象,使用hs-cTnT传统值(14 ng/L)对男性和女性诊断为AMI的灵敏度和特异度分别为99.12%、34.04%和100.00%、53.02%;使用15.5 ng/L(男)和9 ng/L(女)对男性和女性诊断为AMI的灵敏度和特异度分别为100.00%、51.62%和100.00%、30.94%。使用性别特异的cutoff值重新分类后有1例(0.96%)男性患者由AMI调整为不稳定心绞痛(UA),随访30天内未发生心血管不良事件(MACE)。结论使用性别特异的hs-cTnT cutoff值提高了男性患者诊断的特异度和灵敏度,对女性患者诊断的灵敏度无变化,特异度稍有降低,传统的hs-cTnT第99百分位值(14 ng/L)依然可作为老年胸痛患者诊断AMI的标准。

Objective The 99th percentile of sex-specific hypersensitivity cardiac troponin T(hs-cTnT)was used to evaluate the diagnostic value of acute myocardial infarction(AMI)in elderly patients with chest pain.Methods At the chest pain center of west China hospital of Sichuan university,suspected AMI patients who were older than 65 years old and had no typical ST-segment elevation on their ECG were included into the study.Patients clinical data were collected,and the 99th percentile values of traditional and sex-specific hs-cTnT were used to evaluate the clinical value of AMI in elderly patients with chest pain.Results A total of 757 patients met the criteria,with an average age of 75 years,522 males(68.96%)and 235 females(31.04%).The sensitivity and specificity of using traditional hs-cTnT value(14 ng/L)to diagnose AMI in men and women were 99.12%,34.04%and 100.00%,and 53.02%,respectively.The sensitivity and specificity of using 15.5 ng/L(male)and 9 ng/L(female)to diagnose AMI in men and women were 100.00%,51.62%,100%,and 30.94%,respectively.After reclassification using sex-specific cutoff values,there was one case(0.96%)that male patient was adjusted from AMI to unstable angina(UA)and no major adverse cardiovascular events(MACE)occurred within follow-up 30 days.Conclusion For male patients,cutoff value of sex-specific hs-cTnT could improve diagnostic specificity and sensitivity.For female patients,it could not change the sensitivity,but it could slightly reduce the specificity.The 99th percentile value of traditional hs-cTnT(14 ng/L)could still be used as the standard for diagnosing AMI in elderly patients with chest pain.