Serial testing of hs cTn rules out low risk of AMI

Clinical Cases

Cardiology CME/CE Webinar

high sensitive troponin

unstable angina

Dr Evangelos Giannitsis Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany

Dr Hugo Katus Medical Director, Dept. of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Germany

22 October 2020

Key Takeaways

hs-TnT change may be able to rule out low risk of AMI
Serial hs- Tn needs to be done to make the final diagnosis of AMI
Diagnosis of AMI should take into consideration the entire clinical context

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Diagnosis

Unstable angina pectoris with typical signs and symptoms, typical risk factors for coronary heart disease (CHD), normal 12-lead ECG, no indicative laboratory changes. The cTnT-hs concentration was repeatedly below the 99 percentile cut-off value (<14 ng/L).

Coronary angiography revealed several significant sub-occlusive stenoses of the right coronary artery (RCA)

Conclusion

There is no rise or fall in cTnT-hs values needed for AMI diagnosis.

References

DOI: 10.1161/01.CIR.73.3.418
Circulation, 1985 Apr;71(4):699-708. doi: 10.1161/01.cir.71.4.699

hs cTnの連続測定による低リスクAMIのルールアウト

Education & CME

カテゴリーなし

臨床症例

トロポニン

不安定狭心症

高感度トロポニン

case-1

Dr Evangelos Giannitsis Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany

Dr Hugo Katus Medical Director, Dept. of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Germany

22 October 2020

Key Takeaways

高感度トロポニンT（hs-TnT）の変化により、低リスクの急性心筋梗塞（AMI）をルールアウトできる可能性があります。
AMIの最終診断を下すには、高感度トロポニン（hs-Tn）の連続測定が必要です。
AMIの診断は、あらゆる臨床背景を考慮に入れなければなりません。

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診断

典型的な徴候および症状を伴う不安定狭心症で、冠動脈性心疾患（CHD）の典型的な危険因子があり、12誘導心電図は正常で、何らかの状態を示唆する臨床検査値の変化はありませんでした。高感度心筋トロポニンT（cTnT-hs）値は繰り返し99パーセンタイルカットオフ値（<14 ng/L）未満でした。

冠動脈造影では、右冠動脈に重大な閉塞性狭窄がいくつか認められました。

結論

AMIの診断に必要なcTnT-hs値の上昇または低下はありません。

hs cTn 연속 검사로 저위험 AMI을 배제할 수 있습니다

교육 & CME

임상 사례

고감도 트로포닌

불안정 협심증

case-1

Dr Evangelos Giannitsis Cardiologist, Medical Director of Chest Pain Unit, University Hospital of Heidelberg, Germany

Dr Hugo Katus Medical Director, Dept. of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Germany

22 October 2020

Key Takeaways

hs-TnT 수치 변화로 저위험 AMI를 배제할 수 있습니다.
연속 hs- Tn은 AMI 최종 진단을 위해 실시해야 합니다.
AMI 진단은 전체 임상 맥락을 고려해야 합니다.

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진단

전형적인 징후와 증상, 관상동맥 심질환(coronary heart disease, CHD)의 전형적인 위험 인자, 정상 12-lead ECG, 유의미한 검사 수치 변화가 없는 불안정 협심증. cTnT-hs 농도는 반복적으로 99 백분위수 판정기준치(

관상동맥조영술은 우측 관상동맥(right coronary artery, RCA)의 여러 유의한 폐쇄성 협착을 보여주었습니다.

결론

cTnT-hs 값의 상승 또는 하락은 AMI 진단에 있어 필수적인 정보가 아닙니다.