Predictive Value Of Baseline And Variation Values Of High-sensitivity Cardiac Troponin Ⅰ For Revascularization In Patients With Suspected Non-ST-elevation Acute Coronary Syndrome

[Objective]The ongoing high-sensitivity cardiac troponin study in Fuwai Hospital(Clinical Application Research on the Diagnosis of Acute Myocardial Infarction by the Concentration and Dynamic Change of High-sensitivity Troponin I in Chinese Population)has confirmed the feasibility and accuracy in the diagnosis of suspected non-ST-segment elevation acute coronary syndrome(NSTE-ACS)[1].This study further explored the relationship between the baseline value,1 h value,3h value,1h variation value,3h variation value of hs-cTnI and whether patients with suspected NSTE-ACS undergo revascularization.We derived the cut-off values of baseline and variation values of hs-cTnI in patients with suspected NSTE-ACS requiring revascularization.We explored the predictive value of these cut-off values for revascularization in patients with suspected NSTE-ACS,and the correlation between the baseline value,1h value and 3h value of hscTnI and the severity of coronary lesions.[Methods]Patients with suspected NSTE-ACS who admitted to the Emergency Department of Fuwai Hospital of Chinese Academy of Medical Sciences(Fuwai Center)from January 2017 to October 2019 were continuously enrolled in this study.ARCHITECT hs-cTnI level of these patients were detected at the time of visit,1h after visit and 3h after visit,and the diagnosis and treatment were performed according to the normal procedures to collect relevant data.The enrolled patients were divided into drug therapy group and revascularization group according to the treatment plan after admission.We analyzed the relationship between baseline value,1h value,3h value,1h variation value,3h variation value of hs-cTnI and whether patients with suspected NSTE-ACS undergo revascularization.We used ROC curve to derive cut-off values of baseline and variation values of hs-cTnI in suspected NSTE-ACS patients requiring revascularization.These cutoff values were used to predict whether patients with suspected NSTE-ACS in Nanjing and Guangzhou centers underwent revascularization,and sensitivity,specificity,negative predictive value and other indicators were calculated.In this study,the SYNTAX score of all the patients receiving coronary angiography in revascularization group in Fuwai was calculated,and the correlation between the baseline value,1h value,3h value of hs-cTnI and SYNTAX score was analyzed.[Results]In this study,1017 patients in Fuwai Center were statistically analyzed.747 patients received drug therapy and 270 patients received revascularization therapy,respectively.Compared with the drug therapy group,the baseline value,1h value,3h value,1h variation value,3h variation value and 3h relative variation value of hs-cTnI were significantly higher in the revascularization group,with statistical significance(P<0.001).When the suspected NSTE-ACS patients needed revascularization,the overall cut-off values of the baseline value,1 h variation value,and 3h variation value were 10ng/L,2ng/L,and 8ng/L,respectively,the gender-specific cut-off values of males were 1 Ong/L,5ng/L and 6ng/L,respectively,the gender-specific cut-off values of female were 5ng/L,2ng/L and 1ng/L,respectively.Using hs-cTnI baseline cut-off value to predict whether suspected NSTE-ACS patients need revascularization in the general population,men and women,the sensitivity was 85.0%,85.3%and 92.0%,respectively,and the specificity was 70.9%、67.7%、60.4%,respectively,the negative predictive values were 95.2%,93.5%and 98.3%,respectively.Using hs-cTnI 1h cut-off value to predict whether suspected NSTE-ACS patients need revascularization in the general population,men and women,the sensitivity was 80.0%,73.3%and 72.0%,respectively,the specificity was 78.0%,83.6%and 80.2%,respectively,the negative predictive values were 94.2%,90.6%and 95.5%,respectively.Using hs-cTnI 3h cut-off value to predict whether suspected NSTE-ACS patients need revascularization in the general population,men and women,the sensitivity was 69.3%、73.7%、76.0%,respectively,the specificity was 83.2%、80.0%、71.5%,respectively,the negative predictive values were 91.8%、90.2%、95.7%,respectively.Correlation analysis showed that the baseline,1h,3h values of hs-cTnI were positively correlated with SYNTAX score in the general population and the male population(P<0.05),while there was no correlation between the baseline,1h,3h values of hs-cTnI and SYNTAX score in the female population(P>0.05).[Conclusion]The baseline value,1hvalue,3h value,1h variation value and 3h variation value of hs-cTnI were closely related to whether suspected NSTE-ACS patients need revascularization.The sensitivity,specificity and negative predictive value of the general cut-off value and geder-specific value of baseline value,1h variation value,3h variation value of hs-cTnI were high in predicting whether suspected NSTE-ACS patients underwent revascularization,among which the cut-off value of baseline value was more accurate and highly feasible.In the general population and male population,the baseline,1h and 3h values of hs-cTnI were positively correlated with the severity of coronary artery disease.