Implications of Age for the Diagnostic and Prognostic Value of Cardiac Troponin T and I.

IF 7.1 2区医学 Q1 MEDICAL LABORATORY TECHNOLOGY

Clinical chemistry Pub Date : 2024-10-03 DOI:10.1093/clinchem/hvae107

Rasmus Bo Hasselbalch, Philip Andreas Schytz, Martin Schultz, Caroline Sindet-Pedersen, Jonas Henrik Kristensen, Nina Strandkjær, Sophie Sander Knudsen, Mia Pries-Heje, Manan Pareek, Kristian H Kragholm, Nicholas Carlson, Morten Schou, Mikkel Porsborg Andersen, Henning Bundgaard, Christian Torp-Pedersen, Kasper Karmark Iversen

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引用次数: 0

Abstract

Background: The influence of age on cardiac troponin is unclear and may vary between cardiac troponin T (cTnT) and I (cTnI). We aimed to compare the impact of age on the diagnostic and prognostic utility of cTnT and cTnI.

Methods: This Danish nationwide, register-based cohort study included patients with at least one cardiac troponin (cTn) measurement from 2009 through June 2022, stratified into decades of age. We used peak cTn concentration during admission, dichotomized as positive/negative and normalized to the 99th percentile. Receiver operating characteristics for myocardial infarction (MI) and logistic regression were used to estimate the odds ratio (OR) for mortality at 1 year.

Results: We included 541 817 patients; median age 66 years (interquartile range [IQR] 51-77) and 256 545 (47%) female. A total of 40 359 (7.4%) had an MI, and 59 800 (14.1%) patients died within 1 year of admission. The predictive ability of both cTns for MI were highest for patients 30 to 50 years. This was most pronounced for cTnT, the specificity of which fell from 83% among patients 40 to 49 years to 4% for patients ≥90 years. The prognostic ability of both cTns for 1-year mortality declined with age. cTnT had stronger prognostic ability for all age-groups; OR for a positive cTnT 28.4 (95% CI, 20.1-41.0) compared with 9.4 (95% CI, 5.0-16.7) for cTnI among patients <30 years.

Conclusions: The predictive and prognostic ability of cTnT and cTnI declined with age. cTnT had a low specificity for MI in elderly patients. However, cTnT was the strongest prognostic marker among all age groups.

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年龄对心肌肌钙蛋白 T 和 I 诊断和预后价值的影响

背景：年龄对心肌肌钙蛋白的影响尚不明确，而且心肌肌钙蛋白T（cTnT）和心肌肌钙蛋白I（cTnI）之间可能存在差异。我们旨在比较年龄对 cTnT 和 cTnI 诊断和预后效用的影响：这项以登记为基础的丹麦全国性队列研究纳入了从 2009 年到 2022 年 6 月至少进行过一次心肌肌钙蛋白（cTn）测量的患者，并将其按年龄分为不同组别。我们使用入院时的 cTn 峰值浓度，将其分为阳性/阴性，并归一化为第 99 百分位数。使用心肌梗死（MI）的受体操作特征和逻辑回归估算1年死亡率的几率比（OR）：我们共纳入了 541 817 名患者；中位年龄为 66 岁（四分位数间距 [IQR] 51-77），女性患者为 256 545 人（47%）。共有 40 359 名患者（7.4%）发生了心肌梗死，59 800 名患者（14.1%）在入院一年内死亡。两种 cTns 对心肌梗死的预测能力在 30 至 50 岁的患者中最高。这一点在 cTnT 中最为明显，其特异性从 40 至 49 岁患者的 83% 降至≥90 岁患者的 4%。cTnT 对所有年龄组的预后能力都更强；cTnT 阳性的 OR 为 28.4（95% CI，20.1-41.0），而 cTnI 阳性的 OR 为 9.4（95% CI，5.0-16.7）：cTnT 和 cTnI 的预测和预后能力随着年龄的增长而下降。然而，在所有年龄组中，cTnT 是最强的预后标志物。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical chemistry 医学-医学实验技术

CiteScore

11.30

自引率

4.30%

发文量

212

审稿时长

1.7 months

期刊介绍： Clinical Chemistry is a peer-reviewed scientific journal that is the premier publication for the science and practice of clinical laboratory medicine. It was established in 1955 and is associated with the Association for Diagnostics & Laboratory Medicine (ADLM). The journal focuses on laboratory diagnosis and management of patients, and has expanded to include other clinical laboratory disciplines such as genomics, hematology, microbiology, and toxicology. It also publishes articles relevant to clinical specialties including cardiology, endocrinology, gastroenterology, genetics, immunology, infectious diseases, maternal-fetal medicine, neurology, nutrition, oncology, and pediatrics. In addition to original research, editorials, and reviews, Clinical Chemistry features recurring sections such as clinical case studies, perspectives, podcasts, and Q&A articles. It has the highest impact factor among journals of clinical chemistry, laboratory medicine, pathology, analytical chemistry, transfusion medicine, and clinical microbiology. The journal is indexed in databases such as MEDLINE and Web of Science.