급성 심근 경색의 진단에 있어서 cTn-T 추적 검사의 유용성

Abstract

Abstract Diagnostic importance of follow gap of cTn-T in acute myocardiac infarction

Yoon Dae-Heung Advisor : Prof. Cho Soo-hyung M.D Department of Medicine, Graduate School of Chosun University

Background : Cardiac troponin T(cTn-T) is considered a specific marker for the diagnosis of myocardiac infarction(MI) but recent studies have shown cTn-T elevation in a various condition. Our purpose was to define diagnostic importance of cTn-T in acute myocardiac infarction.

Method : cTn-T was measured from stored plasma samples in 482 subjects. Patients were grouped according to the diagnosis of MI. Group Ⅰ(n=380) had no the diagnosis of MI, Group Ⅱ(n=102) had the diagnosis of MI. All group were measured cTn-T at visiting ER, and follow up was done after 3 hrs. The gaps of cTn-T for 3 hrs were compared between the two group.

Result: During the study period, 482 patients had elevated cardiac troponin-T levels. 102 patients(21%) had a diagnosis of AMI, but 380 patients(79%) had non-thrombotic troponin elevation. The follow up gap of acute MI group was significant elevation(mean value :0.392), whereas other group was no significant elevation(mean value:0.055) in our study(p<0.001). The known risk factor of MI had significant importance in our study(p<0.05). The positive predictive value for the diagnosis of AMI was 37%(95% CI, 29-45). The PPV of follow gap of cardiac troponin-T level higher than 0.4 ng/ml in the normal creatinine level was 97% but was as low as 25% for level of below 0.05ng/ml for elderly patients with elevated creatinine level.

Conclusion : The diagnosis of AMI should be based on the clinical presentation, but elevated troponin-T is a common finding and correlated with wrong diagnosis. The diagnostic importance of cardiac troponin-T was established when the follow up gap had a significant elevation and normal renal function.

Keywords : cardiac troponin T, myocardiac infarction, creatinine, follow up.