Sindrome Coronarica Acuta
TROPONINA T-hs
Quali sono le soluzioni diagnostiche a disposizione di chi si prende
cura ogni giorno dei pazienti con Sindrome Coronarica Acuta?
Quali sono le soluzioni diagnostiche a disposizione di chi si prende
cura ogni giorno dei pazienti con Sindrome Coronarica Acuta?
Troponina T-hs
Il ritardo nella diagnosi di infarto miocardico acuto peggiora l’outcome
Cosa dicono le Linee Guida?
Il valore clinico di Troponina T-hs è supportato da numerose evidenze scientifiche
nell’ambito dell’impiego di algoritmi accelerati nella pratica clinica5-7.
nell’ambito dell’impiego di algoritmi accelerati nella pratica clinica5-7.
Per approfondire l’argomento
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JESC: European Society of Cardiology
BIBLIOGRAFIA
1. De Luca G. et al. (2004): Circulation. 109(10) ;1223-5. 2. Twerenbold R et al. European Heart Journal Supplements (2018) 20 (Supplement G), G2–G10 . 3. Roffi M et al. Eur Heart J 2016; 37: 267-315. 4. Collet JP et al. Eur Heart J. 2020 Aug 29;ehaa575. 5. Twerenbold,R. et al. (2019). JACC 74(4), 483 – 94. 6. Chew, D.P. et al. (2019). Circulation Sep 3 doi: 10.1161/CIRCULATIONAHA.119.042891. 7. Stoyanov, K.M. et al. (2019). EHJ ACC 2019 Jul 12:2048872619861911 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa575/5898842#206975919.
BIBLIOGRAFIA
1. De Luca G. et al. (2004): Circulation. 109(10) ;1223-5. 2. Twerenbold R et al. European Heart Journal Supplements (2018) 20 (Supplement G), G2–G10 . 3. Roffi M et al. Eur Heart J 2016; 37: 267-315. 4. Collet JP et al. Eur Heart J. 2020 Aug 29;ehaa575. 5. Twerenbold,R. et al. (2019). JACC 74(4), 483 – 94. 6. Chew, D.P. et al. (2019). Circulation Sep 3 doi: 10.1161/CIRCULATIONAHA.119.042891. 7. Stoyanov, K.M. et al. (2019). EHJ ACC 2019 Jul 12:2048872619861911 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa575/5898842#206975919.
SENSIBILITÀ e SICUREZZA nel rule-out sono fondamentali per poter utilizzare
con tranquillità qualsiasi algoritmo si decida di implementare.
Con Troponina T-hs, oltre a studi prospettici che includono anche gli “early presenters”,
sono disponibili studi di valutazione della applicabilità nella pratica clinica1.
sono disponibili studi di valutazione della applicabilità nella pratica clinica1.
Per approfondire l’argomento
scarica il materiale dedicato!
scarica il materiale dedicato!
LoD: Limit of Detection (Limite di Rilevazione);NPV: Valore predittivo negativo; bNSTE-ACS: Sindrome Coronarica Acuta senza ST sopraslivellato
BIBLIOGRAFIA
1. Chew DP. et al. Circulation 2019;140:1543-1556. 2. NICE Clinical Guidelines https://www.nice.org.uk/guidance/cg95 Ultimo accesso 25.09.2020. 3. Zuin G. et al. G Ital Cardiol 2016;17(6):416-446. 4. Body R, et al. Acad Emerg Med. 2016;23(9):1004-13. 5. Fabbri A, et al. Intern Emerg Med. 2019;14(3):403-410.
BIBLIOGRAFIA
1. Chew DP. et al. Circulation 2019;140:1543-1556. 2. NICE Clinical Guidelines https://www.nice.org.uk/guidance/cg95 Ultimo accesso 25.09.2020. 3. Zuin G. et al. G Ital Cardiol 2016;17(6):416-446. 4. Body R, et al. Acad Emerg Med. 2016;23(9):1004-13. 5. Fabbri A, et al. Intern Emerg Med. 2019;14(3):403-410.
La troponina T cardiaca (cTnT) è un marcatore prognostico indipendente,
capace di preannunciare l’esito a breve, medio e persino lungo termine
dei pazienti con Sindrome Coronarica Acuta (SCA) 1-4.
Le linee Guida ESC 2020 confermano che, mentre hs-TnT e hs-TnI sembrano avere
accuratezza diagnostica comparabile, hs-TnT ha una migliore accuratezza prognostica5.
accuratezza diagnostica comparabile, hs-TnT ha una migliore accuratezza prognostica5.
Valutazione prospettica di pazienti che si presentano al PS con dolore
toracico (n=3.823) stratificati secondo la probabilità clinica di SCA6.
toracico (n=3.823) stratificati secondo la probabilità clinica di SCA6.
Elaborazione grafica di dati da testo, Ref. 6
Sono molteplici le pubblicazioni in cui Troponina T-hs si rivela essere un valido ausilio nella stratificazione del rischio in altre popolazioni di pazienti7-12
HR: hazard ratio; hs-TnI: troponina I ad elevata sensibilità; hs-Tnt: troponina T ad elevata sensibilità; IC: intervallo di confidenza; PPV: valore predittivo positivo;
SCA: sindrome coronarica acuta.
BIBLIOGRAFIA
1. Aviles RJ, Askari AT, Lindahl B, et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl JMed 2002;346:2047-2052. 2. Lindahl B, Venge P, James S. The new high- sensitivity cardiac troponin T assay improves risk assessment in acute coronary syndromes. Am Heart J 2010;160:224-229. 3. Haaf P, Reichlin T, Twerenbold R, et al. Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. Eur Heart J 2014;35(6):365-375. 4. Bjurman C, Larsson M, Johanson P, et al. Small changes in troponin T levels are common in patients with Non- ST-elevation myocardial infarction and are linked to higher mortality. J Am Coll Cardiol2014;62(14):1231-1238. 5. Collet JP et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020 Aug 29;ehaa575. 6. Badertscher P et al. Effect of pre-test probability on diagnostic and prognostic performance of high-sensitivity cardiac troponin for acute myocardial Infarction European Heart Journal, Volume 38, Issue suppl_1, 1 August 2017, ehx501.54. 7. Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129-2200. 8. Thygesen K, et al. Fourth definition of myocardial infarction. J Am Coll Cardiol 2018;30:72(18):2231-2264. 9. Latini R, et al. On the behalf of the GISSIAF Investigators. Circulating cardiovascular biomarkers in recurrent atrial fibrillation: data from the GISSI-Atrial fibrillation trial. J Intern Med 2011;269(2):160-171. 10. Duceppe E, et al. Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients undergoing noncardiac surgery. Canadian Journal of Cardiology Can J Cardiol. 2017;33(1):17-32. 11. Puelacher C, et al. Perioperative myocardial injury after noncardiac surgery: incidence, mortality, and characterization. Circulation. 2018; 137(12):1221-1232.12. Writing Committee for the VISION Study Investigators, Devereaux PJ, et al. Association of postoperative high sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017; 317(16):1642-1651.
BIBLIOGRAFIA
1. Aviles RJ, Askari AT, Lindahl B, et al. Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction. N Engl JMed 2002;346:2047-2052. 2. Lindahl B, Venge P, James S. The new high- sensitivity cardiac troponin T assay improves risk assessment in acute coronary syndromes. Am Heart J 2010;160:224-229. 3. Haaf P, Reichlin T, Twerenbold R, et al. Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. Eur Heart J 2014;35(6):365-375. 4. Bjurman C, Larsson M, Johanson P, et al. Small changes in troponin T levels are common in patients with Non- ST-elevation myocardial infarction and are linked to higher mortality. J Am Coll Cardiol2014;62(14):1231-1238. 5. Collet JP et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020 Aug 29;ehaa575. 6. Badertscher P et al. Effect of pre-test probability on diagnostic and prognostic performance of high-sensitivity cardiac troponin for acute myocardial Infarction European Heart Journal, Volume 38, Issue suppl_1, 1 August 2017, ehx501.54. 7. Ponikowski P, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016;37:2129-2200. 8. Thygesen K, et al. Fourth definition of myocardial infarction. J Am Coll Cardiol 2018;30:72(18):2231-2264. 9. Latini R, et al. On the behalf of the GISSIAF Investigators. Circulating cardiovascular biomarkers in recurrent atrial fibrillation: data from the GISSI-Atrial fibrillation trial. J Intern Med 2011;269(2):160-171. 10. Duceppe E, et al. Canadian cardiovascular society guidelines on perioperative cardiac risk assessment and management for patients undergoing noncardiac surgery. Canadian Journal of Cardiology Can J Cardiol. 2017;33(1):17-32. 11. Puelacher C, et al. Perioperative myocardial injury after noncardiac surgery: incidence, mortality, and characterization. Circulation. 2018; 137(12):1221-1232.12. Writing Committee for the VISION Study Investigators, Devereaux PJ, et al. Association of postoperative high sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2017; 317(16):1642-1651.