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[摘要] P. Kavsak and A. Jaffe raise some important issues regarding the diagnostic and prognostic utility of change criteria with high-sensitivity troponin assays in patients with acute coronary syndromes (1).Our recently published study (2) evaluated a cohort of 939 patients presenting with chest pain, with an acute myocardial infarction (AMI)1 rate of 21.3%. In patients with a peak concentration (at 0–2 h) in the Roche high-sensitivity cardiac troponin T (hs-cTnT) assay ≥99th percentile, use of the relative change between 0 h and 2 h after presentation significantly improved the specificity but reduced the sensitivity for the diagnosis of AMI. The authors refer to a recent publication that demonstrated that absolute changes in troponin outperform relative changes between 0 h and 1 h or 2 h after presentation for the diagnosis of AMI (3). The area under the ROC curve (AUC) was 0.95 for absolute changes and 0.76 for relative changes. The AUCs for absolute values (irrespective of the change) were reported for baseline concentrations (0.94 and 0.95 for hs-cTnT and hs-cTnI, respectively) but not peak concentrations for comparison. The ROC curve–determined optimum for absolute change was 0.007 μg/L. An analysis of our study showed that the …

[学科分类] 过敏症与临床免疫学