CP NHT CHN ON

NHI MU C TIM
&
XT NGHIM TROPONIN I SIU NHY

GS. TS. BS. ng Vn Phc

Ch Tch Hi Tim Mch TP. HCM

NI DUNG TRNH BY

1. Cp nht chn on NMCT

2. Xt nghim troponin I siu nhy

3. S dng troponin I siu nhy trong chn

on NMCT cp

4. S dng troponin I siu nhy trong tin lng

NMCT cp

Cp nht chn on NMCT

Huyt khI x va qu trnh bnh l ton thn

v tin trin 1,2
Thrombosis

UA
MI

ACS

Ischemic
stroke/TIA
Vascular death

Stable angina
UA=unstable angina; MI=myocardial infarction;
ACS=acute coronary syndrome; TIA=transient ischemic attack
1. Adapted from Libby P. Circulation 2001;104:365372.
2. Drouet L. Cerebrovasc Dis 2002;13(Suppl 1):16.

X va ong mach theo thi gian

Bot bao

Dai m

Ton thng
Trung gian X va

Mang
si

Ton thng
bien chng/v

Roi loan chc nang noi mac

thap nien th 1

t thap nien th 3

t thap nien th 4

Tnh trang viem mach mau: (d lieu hoa sinh BN hoi chng mach vanh cap)
Cac cytokine
tien viem
IL-6
TNFa

Mat tnh on
nh mang
MMP-9*
MPO*
ICAM
VCAM

Thieu mau cuc bo

IMA*
FFAu*
Choline*

V mang
sCD40L
PIGF
PAPP-A*

Hoai t
cTnT
cTnI

Chat phan
ng giai
oan cap
CRP

Roi loan chc

nang c tim
BNP
NT-proBNP

T mng
x va
n
HC/MVC

TL: Antman E M,
Braunwald. In Braunwalds
Heart Disease, ed, by Libby,
Bonow, Mann, Zipes.WB
Saunders 2008, 8th ed, p
.1210

ACS: ECG-Diagnosis & Triage

Ischemic Discomfort

No ST Elevation

ST Elevation

NSTEMI

Unstable Angina Non Q-wave MI

Q-wave MI

ACUTE CORONARY SYNDROMES

Phan loai hoi chng mach vanh cap

Admission
Working
diagnosis
ECG

Chest Pain
Suspicion of Acute Coronary Syndrome
Normal or Undetermined
Persistent
ST/T ST - elevation Abnormalities
ECG

Biochemistry

Troponin
positive

Risk
stratification
Diagnosis
Treatment

High Risk
STEMI

NSTEMI

Reperfusion Invasive

Troponin
2 x negative

Low Risk
Unstable
Angina
Non-invasive

au ngc ti khoa Cp Cu

Xut vin

100 triu lt hng nm (Hoa K)

Nhp vin
6 triu lt do au ngc

2,000,000
Khng do tim
24,000
B st
HCMVC

4,000,000
Nghi ng hoc c
bnh tim thc s
1,360,000
Khng do tim
910,000
Bnh tim khc
900,000
TN (n nh/Khng n
nh)
830,000
NMCT

NCHS, Hospital Discharge Data, 2002

Pope et al, NEJM, 2000

Tn sut chn on b st H/C MVC

Hospitalization

Emergency
Department

Day 1

Discharge

Day n

Day 2

Q-wave
27%

4%

Non-Qwave
63%

~ 75% stable
8-13%

18%

25-50%

Complications with
Aggressive management

Discharged home
Missed diagnosis
Arrhythmic or
Heart failure death

Sudden cardiac death

Crawford. Cardiology 2nd ed. Mosby. 2004: 359

Crawford. Cardiology 2nd ed. Mosby. 2004: 359

Bin i nng cc ch im
sinh hc theo thi gian/ NMCT
cp

Nng gia tng theo kch thc nhi mu

French J and White H Heart 2004; 90(1): 99106.

Tng quan du n tim mch

Trng lng phn t, phng thch, c hiu, nhy

French J and White H Heart 2004; 90(1): 99106.

nh ngha NMCT thay i t thp nin 1950s

Small heart attacks are so common
that they are within the normal range
Consensus Document

Myocardial infarction redefined - A consensus

document
of The Joint European Society of
Cardiology/American
College of Cardiology Committee for the
Redefinition of
Myocardial infarction
The Joint European Society of Cardiology/
American College of Cardiology Committee**
The Joint ESC/ACC Committee Eur Heart J 2000; 21:1502-13, JACC 2000;36:959-69

Ref: Thygesen, Alpert, White. Universal Definition of Myocardial Infarction 2007 EHJ, JACC, CIRC

Lch s cc du n tim
mch

AST, angiotensin sensitivity test; CK, creatine kinase; INH, immunoassay; LD, lactate dehydrogenase

Thay i Tiu chun trong

NH NGHA NHI MU C TIM

Cardiac Troponin (T/I) trong HCMVC

Dng t do
trong bo
tng (cytosol)
phng thch
sm (3%-6%)

Dng
phc
hp gn kt vi
si actin phng
thch sau

B my Co bp ca c tim

Phc hp Troponin: Mt bn
ch ng
Troponin I
Trng lng phn t 20-25 kDA,
c ch men actomyosin-ATPase

Troponin T
Trng lng phn t 30-34 kDA,
Bc cu vo tropomyosin

Troponin C
Vng gn kt vi Calcium, C mi ch

C cu sinh hc hai khoang ca

troponin
C quan gy co c
Troponin trong bo tng

Gy phng thch
troponin sm

Gy phng thch troponin

chm/ko di

Cc dng Troponin lu hnh trong tun hon

C TnT v TnI c tm thy
trong tun hon di nhiu
dng khc nhau: phc hp
tam phn, phc hp nh
phn (ch yu l TnI-TnC)
v dng t do1
Ternary complex

Binary complex
Free form

1 Korff S et al, Heart, 2006; 92: 987-993.

2 Wu A et al, Clin Chem 1998; 44:1198
1208.

TnT ch yu tn ti dng
t do trong tun hon2
TnI b phn hy c trong ng
nghim ln c th nn nh
hng n n nh

Cc xt nghim troponin c
nhy cao
Cc xt nghim nh lng troponin mi, c chnh xc rt
cao, tc l sai s CV <10% (CV: co-efficient of variation l h
s bin thin hay lp li ca cng mt mu xt nghim)
mc 99% bch phn ca qun th bnh thng mnh khe
(hay l gi tr cao nht trong gii hn bnh thng)

Gii hn ca Troponin hin ang s

dng

Tn 0h + Tn 6h
ECG Monitoring 6-8h
Time + Ressources

Troponin-blind Interval

Loi tr nhanh chng HCMVC vi Tn siu

nhy

ESC Guidelines
2011

Figure 1: GRACE = Global Registry of Acute Coronary Events; hsTn = highsensitivity troponin;
ULN= upper limit of normal, 99th percentile of healthy controls. change, dependent on assay.
At the end of this step, the decision has to be made whether the patient should go on to cardiac
catheterization

Cc im ct (cut-off points) ca TnT

Gen. 4th
Chuyn i t:
im ct c theo WHO (0.1
g/L) ca cTnT
im ct hin ti CV 10%
(0.035 g/L) ca cTnT
Theo im ct 99% bch
phn ca hs-cTnT

Hs-cTnT
ug/l

Mi

cTnT
ug/l

1.0

1.0

Bnh l

0.5
0.4
0.3

0.5
0.4
0.3
0.2

0.2

0.1
0.1

0.060

0.014

Bnh thng
0.002

C kh nng bnh

0.035
0.010
<0.01
<0.01

<0.01

C kh nng bnh thng<0.01

<0.01

Cn bng gia nhy v c hiu

nhy

Pht hin NMCT sm hn

BS xc nh ngay khi c thay i
nng Tn

BN c gi ti phng thng tim

Kt qu Tn dng tnh gi

c hiu

Hiu qu phn bit NMCT cp vi

tn thng c tim mn

S BN chp MV

T tin ca BS khoa cp cu khi gi tr

Tn dng tnh

Suy tim mn, thuyn tc phi,

vim c tim v bnh mn tnh
khc hoc tn thng c tim nh
c th thng xuyn tng Tn >
99th percentile
Du hiu chnh phn bit trng hp cp so vi mn l s thay i gi tr ca cTn

NH NGHA NHI MU C TIM

Theo cc ng thun ton cu

NH NGHA NHI MU C TIM

NMCT cp c nh
ngha l cht t bo c
tim do thiu mu c
tim ko di
Men tim c hiu phi tng

Phn loi NHI MU C TIM

Theo ng thun ton cu 2012
Type 1: NMCT xy ra t nhin (nguyn pht)
Type 2: NMCT th pht do mt cn bng cung cu xy
c tim
Type 3: NMCT gy ra t t
Type 4a: NMCT lin quan can thip, do th thut
Type 4b: NMCT lin quan can thip, do huyt khi stent
Type 5: NMCT lin quan m bc cu

Phn loi NHI MU C TIM

Theo ng thun ton cu 2012

Phn loi NHI MU C TIM

Theo ng thun ton cu 2012

NMCT cp type 1
do v mng x va t nhin

Khi pht do mng x va b v, lot, hoc bc

tch, gy huyt khi lng MV

NMCT cp type 2 do mt cn bng

cung cu xy c tim ngoi BMV
Khi pht khng do huyt khi- x va

NMCT type 2: tn thng hoi t c tim xy ra khi c

nguyn nhn khc ngoi BMV gp phn lm mt cn
bng cung cu xy c tim (vd: RL chc nng ni m
mch vnh, co tht mch vnh, thuyn tc, RL nhp nhanhchm, thiu mu, suy h hp, chong nhim trng,Tt
HA hay THA)

Phn bit gia NMCT cp type 1 v 2

Vic lm khng d dng trn lm sng
NMCT type 2 c th xy ra trn:
Mch vnh co tht

Mch vnh x va

Mch vnh bnh thng

Phn bit gia NMCT cp type 1 v 2

Cc gi lm sng hn l Tiu chun
NMCT cp type 1

NMCT cp type 2

C biu hin lm sng kh

in hnh

C nguyn nhn bnh l khc

Du hiu bt thng ca
thiu mu trn ECG, vi nhp
tim v huyt p bnh thng

Nhp tim/huyt p thay i

tng ng vi nhu cu ti
mu

Khng c biu hin ca

nguyn nhn khng phi
huyt khi

Du hiu lm sng theo bnh

nn

Tiu chun cho NMCT cp type 2

Saaby et al.
Gim cung cp
Hb < 5.5 mmol/L (nam),
< 5.0 mmol/L (n)

Shock vi HA tm thu < 90

mmHg, ri lon a c quan
Chm nhp tim cn phi iu tr
Thuyn tc MV
Suy h hp, Oxy mu M <
8kPa, vi biu hin suy h hp
ko di trn 20 pht

Tng nhu cu
Ph phi tng huyt p: huyt
p tm thu > 160 mmHg, ph
phi trn lm sng, xquang
Tng huyt p ng mch >
160 mmHg, ph i tht tri
trn ECG hoc siu m tim

NMCT cp type 3 do t t

t t vi du hiu gi
TMCT, ECG xut hiu thiu
mu mi hoc block nhnh
tri. Tuy nhin t vong trc
khi c th ly mu nh gi
thay i men tim.

NMCT cp type 4a do can thip mch vnh

NMCT c lin quan n PCI.

Nng troponin tim tng x 5
ln gi tr 99th percentile trn
bnh nhn ang c cTn bnh
thng, hoc tng > 20% nu
gi tr nn ang tng hoc gim.

NMCT type 4b do huyt khi Stent

NMCT lin quan n huyt

khi trong stent, pht hin
bng chp mch vnh hay
khm nghim t thi, trong
bnh cnh TMCT c km
tng/gim men tim vi t nht
mt gi tr trn ngng
99th ile.

NMCT cp type 5 do CABG

NMCT lin quan n CABG,
vi gi tr cTn trn 10 ngng
99th ile bnh nhn ang c
cTn bnh thng, km theo
ECG xut hin sng Q mi
hoc block nhnh tri mi
hoc chp mch vnh cho
thy tc nghn mi hoc hnh
nh cho thy vng tim
chuyn ng bt thng.

Cc nh ngha NMCT cp
Cc loi c bit
Ti nhi mu

NMCT cp xy ra 28 ngy sau NMCT trc

Nhi mu c tim ti pht

NMCT cp xy ra 28 ngy sau NMCT trc

Nhi mu c tim im lng

Khng triu chng, c bng chng sng Q

Tiu chun chn on

Ti NMCT

Chn on NMCT cp
(WHO)
Da trn c t nht 2 trong 3 tiu chun:
1) Cn au tht ngc hoc tng ng
2) Bin i in tim ph hp vi Thiu mu c tim
cc b hay Nhi mu c tim
3) Gia tng cc men tim c hiu ( CK-MB; Troponin
T; Troponin I )

Vn c ngha trong bnh cnh cp cu: thng

thng thi im c 2 tiu chun (1) v (2)

Tiu chun chn on NMCT

ESC/ACCF/AHA/WHF 2007
Pht hin gia tng v/hoc gim sau ca men
tim (c bit Troponin) t nht mt gi tr trn bch
phn v 99 URL cng vi mt trong cc biu hin
sau:
Triu chng TMCT;
Bin i TMCT mi trn ECG ( thay i ST-T mi,
block nhnh tri mi xut hin )

Xut hin sng Q bnh l trn ECG

Chng c hnh nh hc mt mi vng c tim cn
sng hoc RL vn ng vng mi
Redefinition of Myocardial Infarction of the join ESC/ACCF/AHA/WHF- 2007

Tiu chun chn on NMCT

ESC/ACCF/AHA/WHF 2012
Pht hin s gia tng v/hoc gim ca men tim (c bit
cTn) vi t nht mt gi tr trn bch phn v 99 URL cng vi
mt trong cc biu hin sau:
Triu chng TMCT;
Bin i TMCT mi trn ECG ( thay i ST-T mi,
block nhnh tri mi xut hin )
Xut hin sng Q bnh l trn ECG
Chng c hnh nh hc mt mi vng c tim cn sng
hoc RL vn ng vng mi
Nhn din huyt khi mch vnh bng chp mch hoc
t thit

Men tim - du n sinh hc pht hin

NMCT

Men Troponin tim tng cao do

tn thng c tim (Myocardial Injury)
Tn thng do thiu mu c tim nguyn pht (NMCT type 1)
Tn thng do mt cn bng cung/cu xy c tim (NMCT
type 2)
Tn thng khng lin quan thiu mu c tim
Tn thng c tim do a yu t hay khng xc nh c

Tng men tim c hiu l iu kin cn thit

quan trng nhng cha l iu kin

Men Troponin tim tng cao do

tn thng c tim (Myocardial Injury)
Tn thng do thiu mu c tim nguyn pht

Tn thng khng do thiu mu c tim

Tn thng do mt cn bng
cung/cu xy c tim
Tn thng c tim do a NN hay khng xc nh

Cc nguyn tc phn bit NMCT

vi Tn thng c tim do nguyn nhn khc

Men Troponin tim: theo di bin i ng hc

men tim, ch s gia tng men tim cp vi tng
mn
Lm sng: Ch phn bit cc nguyn nhn
cp vi cc nguyn nhn khc

Xt nghim Troponin I siu nhy

Khong pht hin ca cc th h xt nghim

cTn khc nhau

Nng Troponin

>8-12 sau
s c

Xt nghim Troponin trc y

Xt nghim Troponin hin ti

Bt u nhi mu c tim
2-6 sau s c

Xt nghim Troponin nhy cao

Bch phn v th 99

Nng bnh
thng

Thiu mu hoc
hoi t nh

Hoi t

Adapted from: Hochholzer, W, et al,, Am Heart J, 2010, 160(4): 583-594

nh ngha xt ngha Troponin tim siu nhy

Lin on quc t v ha lm
sng (International Federation
of Clinical Chemistry-IFCC)
khuyn co 1
sai bit ti bch
phn v th 99 :

10% cv

Trong khong t gii hn pht

hin (Limit of detection LoD) n
bch phn v th 99 phi o c
t nht

50%

C th khe
mnh

Hi Tim mch Chu u

(European Society of
Cardiology -ESC)
Khuyn co 2
Khong thi gian lm li xt
nghim khi s dng xt nghim
nhy cao trong quyt nh xut
vin l

3 gi
References:
1, Apple_Clin Chem 2012 58(11) p 54-61
2, Hamm_EHJ 2011, 32 p,2999-3054

Xt
nghim
cTn nono
l l
xt
siu
nhy?
Xt
nghim Troponin
xtnghim
nghim
nhy
cao?
Nng Troponin tim
LoD (ngng
pht hin),a ng/L

Bch phn
v th 99
ng/L (CV)b

10% CV, ng/L

% pht hin dn s bnh

thng 1

Abbott
ARCHITECTd

1,2

16 (5,6%)

3,0

96

Beckman Accessc

2-3

8,6 (10%)

8,6

80

Nanosphere MTPc

0,2

2,8 (9,5%)

0,5

N/A

Singulex Erennac

0,09

10,1 (9,0%)

0,88

100

Siemens Vistac

0,5

9 (5,0%)

86

5,0

14 (8%)*

13

25**

Tn cng ty/H
thng/Xt nghim
hs-cTnl

hs-cTnT
Roche Elecsys d

gii hn pht hin,

bch phn v th 99,
c Cha pht trin v khng c cho mc ch thng mi,
d S dng ton cu nhng cha c FDA thng qua cho s dng nc M,
a LoD,

b CV

References:
Adapted from: Apple, F,S,, et al, Clin Chem, 2012; 58 (1) :5461
*Correction to the January 2012 Mini Review - Apple, F,S,, et al, Clin Chem; 2012; 58 (4): 796
**This value is based upon results using the Roche Cobas, The same reagent is used for both the Roche Elecsys and Cobas instruments and the performance is the same
1 Apple, F,S,, et al, Clin Chem, 2012; 58(11) :1574-1581

Khng o c!

LoD xt nghim
hin ti

LoD ca nhy cao

Khng o c

Tn sut

ARCHITECT
Troponinsiu
I siu
nhy
ARCHITECT
STAT Troponin-I
nhy

10% CV

Nng TnI
10% CV
4,7 pg/mL
Cartoon for ARCHITECT STAT hsTnI
ARCHITECT STAT hs Troponin-I Package Insert G45454/R03

Nam
N
Overall
15,6 pg/mL 26,2 pg/mL 34,2 pg/mL

99th %ile
chnh xc

5,3% CV

4,0% CV

3,5% CV

Ngng ct ring cho nam v n

Phn b Nam v N theo tng nhm HCVC

50%
45%

45%

40%
33%

32%

30%

au ngc khng n nh
22%

23%
NSTEMI

20%

STEMI
10%

0%
N

Reference: Copyright with permission El-Menyar A,, et al,, J,Am Card,,,2009: 1018-1022

Nam

T l t vong nam n
Bnh nhn nhp vin vi nhi mu c tim cp cc quc gia khc nhau
Year

Thit k
nghin cu

Hoa K

2005

Hi cu

14552/21323

2002

Hi cu

2006

Thi Lan

Quc gia

Ti ti mu

N/Nam

(N so vi Nam)

T vong
(N so vi Nam)

PCI: 31% vs 40%

6% vs 4%

225/653

Th: 19% vs 41% (p <0,001)

24% vs 13% (p <0.0001)

Tin cu

2033/4033

Th: 41% vs 51% (p <0,02);

PCI: 6% vs 9% (p <0,04)

21% vs 12% (p <0.06)

2007

Tin cu

1223/2613

Th: 28% vs 31% (p <0,03);

PCI: 39% vs 49% (p <0,001)

24% vs 14% (p <0.001)

Israel

2000

Tin cu

742/2175

Th: 42% vs 48% (p = 0.03);

PCI: 11% vs 15% (p = 0.007)

18% vs 10% (p <0.0001)

Lebanon

1999

Tin cu

99/334

NA

16% vs 8% (p <0.03)

Kuwait

2001

Hi cu

89/267

Th: 40% vs 62% (p = 0.001)

21% vs 11% (p = 0.02)

Qatar

2004

Hi cu

451/1147

Th: 19.5% vs 28.4% (p = 0.08)

24% vs 14% (p = 0.02)

Nghin cu
hin ti

2009

Tin cu

1983/6183

Th: 80% vs 84% (p = 0.17);

PCI: 5% vs 8% (p = 0,07)

14% vs 5% (p <0.001)

NA = not available; Th = thombolysis; PCI = percutaneous coronary intervention

Reference: adapted from El-Menyar A,, et al,, J, Am Card,,,2009: 1018-1022

Xt nghim TnI siu nhy v TnI thng thng

ARCHITECT

STAT Tnl (LN 2K41)1

ARCHITECT

STAT

hsTnl (LN 3P25)2

g/L
(ng/mL)

pg/mL
(ng/L)

g/L
(ng/mL)

pg/mL
(ng/L)

0,010*

10*

0,002**

1,9**

N/A

N/A

0,01

10

10% CV

0,032

32

0,005

4,7

Bch phn v th 99 (chung)

0,028

28

0,026

26,2

Bch phn v th 99 (nam)

0,033

33

0,034

34,2

Bch phn v th 99 (n)

0,013

13

0,016

15,6

nhy phn tch*/LoD**

LoQ

% dn s pht hin > LoD3

<50% bnh thng

>50% bnh thng

Ci thin nhy vi LoD thp hn

References:
1 ARCHITECT STAT TnI Package Insert 840653_R08,
2 ARCHITECT STAT hs Troponin-I Package Insert G45454/R03
3 Apple, F,S,, et al, Clin Chem, 2012; 58(11): 1574-1581,

Ci thin nng 10% CV gp 7

ln m khng thay i bch phn
v th 99
Cho php rt ngn thi gian theo
di t 6 gi xung cn 3 gi

Xt nghimTnI siu nhy v TnT siu nhy

Clin Biochem (2013), http://dx.doi.org/10.1016/j.clinbiochem.2013.11.019

I siucho
nhy ROC
cho ROC
curvett
tt hn
TnI Troponin
siu nhy
curve
hn TnT siu nhy

Clin Biochem (2013), http://dx.doi.org/10.1016/j.clinbiochem.2013.11.019

Troponin I siu nhy t b nh hng bi bnh l

thn hn Troponin T siu nhy

Slide courtesy of Prof. Aw Tar Choon, Changi General Hospital, Singapore

TSIC symposium 2014, Hochiminh city, Vietnam

Thay i ca xt nghim Troponin I v T siu nhy

theo eGFR

cTn Elevation (%)

hs-TnT

hs-TnI

> 90

60-89 45-59 30-44

15-29 < 15

eGFR (mL/min)
Slide courtesy of Prof. Aw Tar Choon, Changi General Hospital, Singapore
TSIC symposium 2014, Hochiminh city, Vietnam

Xt nghim Troponin I siu nhy trong

chn on NMCT cp

Chn on loi tr da trn ngng pht hin thp nht (LoD)

Chn on loi tr da trn ngng pht hin thp nht (LoD)

Nghin cu a trung tm quc t, t

4/2011 11/2011
BN > 18 tui, nhp cp cu vi nghi ng c
HCMV cp trong vng 12 gi, khng mc
bnh thn giai on cui

Xn: hsTnI (Abbott),

hsTnI (Siemen),
hsTnI (Bckman Coulter),
hsTnT (Roche)
Cc Xn khc
T/di trong 30 ngy, v sau 24 thng

Chn
on
loi
tr
phthin
hin
thp
nht
(LoD)
Chn
on
loi
trda
datrn
trn ngng
ngng pht
thp
nht
(LoD)

Rubini Gimnez, et al,, Int J Cardiol , 2013;168:3896-3901

Chn on/loi tr sm NMCT

Copyright with permission Hamm et al., Eur Heart J. 2011;32:29993054.

 ngh ca Abbott trong bin lun kt qu hsTnI

au ngc cp NSTE-ACS

NGUY C
Xt nghim
nn hsTnI

Nam34.2 pg/mL (ng/L)

N 15.6 pg/mL (ng/L) 6,7

<Gii hn pht
hin (ng/L)3,5,7

au>6 Gi1

Nam 34.2 pg/mL (ng/L)

N 15.6 pg/mL (ng/L) 6,7

Kt qu cao bt thng
(10x gi tr phn v th 99) +
Biu hin lm sng1,8

au< 6 Gi1

Xt nghim li hsTnI sau 3 gi1,3,7

hsTnI
Thay i khng ng k

Thay i 50%3,7
v/hoc
> Gi tr phn v th 99 theo tui

hsTnI
Thay i khng ng k

Khng au ngc, GRACE<140 hoc TIMI

1, loi tr chn on phn bit d1,4

Xut vin/Test gng sc 1

iu tr xm ln1

Tm chn on phn bit 1

iu tr xm ln

*Mi bnh vin phi xc nh delta ph hp cho bnh nhn, y c th l im bt u tt nh gi cc mc

ch
hsTnI= Abbott STAT high sensitive troponin I, GRACE=global registry of acute coronary events, TIMI=thrombolysis UA/NSTEMI, NSTE-ACS = Non ST Elevation Acute
Coronary Syndrome

Xt nghim Troponin I siu nhy trong tin

lng NMCT cp

Gi tr tin lng ca Troponin siu nhy trn bnh nhn

NSTEMI
12%

hsTnI 26 ng/mL
n = 3992

T vong tim mch do MI (%)

10%

8%

iu chnh OR 3,7
95% CI 2,3 5,7
p < 0,001

6%

4%

hsTnI < 26 ng/mL

n = 703

2%

0%
0

20

10

Ngy

Copyright with permission from Bhoula May, et al,, Clin Chem 2014; 60(1): 158-164,

30

Gi tr tin lng ca Troponin siu nhy trn bnh nhn

NSTEMI
12%

LoD

Phn v th 99

10%

T vong tim mch do MI (%)

9,7%
8%

P trend < 0,001

6%

4,4%

4%

3,2%
2%

Khng c bnh nhn

c hsTnI khng th
pht hin

1,6%

0%

<1,5

1,5 to <6

6 to <11

11 to <26

26

n = 257

n = 217

n = 229

n = 3992

Nng hs-cTnI(ng/L)

Quan h c phn bc gia hs-cTnI v t vong tim mch do MI ngy 30.

Testing for a trend across all categories of hs-cTnI was significant (P-trend < 0,001),

Copyright with permission from Bhoula May, et al,, Clin Chem 2014; 60(1): 158-164,

T vong tim mch hoc suy tim (%)

5
10

15

Tin lng trong t vong do tim mch v suy tim theo nng
Troponin siu nhy

p<0,001

Quartile 1

Quartile 2

3
Nm
Quartile 3

Quartile 4

Nguy c T vong tim mch hoc Suy tim theo gi tr nng nn hs-TnI
Copyright with permission from Omland, T, et al, J of Am Coll Cardio, 2013; 61(11): 1240-1249,

KT LUN
1. Theo khuyn co ng thun ton cu mi nht,
men tim c hiu l yu t then cht trong chn
on NMCT
2. NMCT theo bnh cnh v nguyn nhn nn c
phn chia thnh 5 type khc nhau
3. NMCT type 2 thng gp BN hi sc nguy kch
v thi x tr c khc bit vi NMCT tp 1

4. NMCTC type v 5 lin quan n cc k thut iu

tr ti ti mu

5. Fdskjfsld
1.
2.
3.
4.

Fhsdf
Kjdhslkjhf
hfjskhfkds]
Fdkslfj

KT LUN

5. Gia tng men tim c hiu l CN nhng cha , cn

theo di ng hc men tim, v phi hp lm sng.
6. Cc men tim Troponin siu nhy, c bit l Troponin I siu
nhy gip chn on sm v loi tr sm NMCT cp, rt
ngn bc chn on cn 3 gi

7. Troponin I siu nhy c ngng ct chn on ring gii

nam v gii n
8. Troponin I siu nhy t b nh hng bi suy thn/s gim
lc cu thn
9. Troponin I siu nhy c gi tr tin lng bnh nhn NMCT

Troponin I siu nhy gp phn gip tng kh nng chn on

NMCT cp sm hn v c hiu hn

Xin chn thnh cm n!