Purpose: Established diagnostic thresholds for high-sensitivity cardiac troponins (hs-cTn) might not apply for elderly patients as they are elevated irrespective of the presence of an acute myocardial infarction (AMI). Aim of the present study was to investigate hs-cTnI in elderly patients with suspected AMI and to calculate optimized diagnostic cutoffs. Material and methods: Data from a prospective multi-centre study and from a second independent prospective single-centre cohort study were analysed. A number of 2903 patients were eligible for further analysis. Patients > 70 years were classified as elderly. hs-cTnI was measured upon admission. Results: Around 34.7% of 2903 patients were classified as elderly. Around 22.5% of elderly patients were finally diagnosed with AMI. Elderly patients had higher hs-cTnI levels at admission irrespective of the final diagnosis (p < 0.001). According to the AUROC, hs-cTnI was a strong marker for detection of AMI in elderly patients. Application of the 99th percentile cutoffs showed a substantially lower specificity in elderly. By using optimized thresholds, specificity was improved to levels as in younger patients in both cohorts but accompanied with a decrease in sensitivity. Conclusions: hs-cTnI levels have a lower specificity for detecting AMI in elderly patients. This lower specificity can be improved by using hs-cTnI thresholds optimized for elderly patients.

中文翻译：

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使用优化的高度敏感的肌钙蛋白I阈值鉴定老年患者的急性心肌梗塞。

目的：既定的高敏感性心肌肌钙蛋白（hs-cTn）诊断阈值可能不适用于老年患者，因为他们升高了，而不论是否存在急性心肌梗塞（AMI）。本研究的目的是调查疑似AMI的老年患者的hs-cTnI并计算优化的诊断临界值。材料和方法：分析来自前瞻性多中心研究和第二项独立的前瞻性单中心队列研究的数据。有2903名患者符合进一步分析的条件。> 70岁的患者被分类为老年人。入院时测定hs-cTnI。结果：2903名患者中约有34.7％被归类为老年人。最终约22.5％的老年患者被确诊为AMI。老年患者入院时hs-cTnI水平较高，与最终诊断无关（p <0.001）。根据AUROC，hs-cTnI是检测老年患者AMI的有力标记。第99个百分位数的临界值的应用显示出老年人的特异性大大降低。通过使用优化的阈值，在这两个队列中，特异性都提高到了年轻患者的水平，但伴随着敏感性的降低。结论：hs-cTnI水平检测老年患者的AMI的特异性较低。通过使用针对老年患者优化的hs-cTnI阈值，可以改善这种较低的特异性。第99个百分位数的临界值的应用显示出老年人的特异性大大降低。通过使用优化的阈值，在这两个队列中，特异性都提高到了年轻患者的水平，但伴随着敏感性的降低。结论：hs-cTnI水平检测老年患者的AMI的特异性较低。通过使用针对老年患者优化的hs-cTnI阈值，可以改善这种较低的特异性。第99个百分位数的临界值的应用显示出老年人的特异性大大降低。通过使用优化的阈值，在这两个队列中，特异性都提高到了年轻患者的水平，但伴随着敏感性的降低。结论：hs-cTnI水平检测老年患者的AMI的特异性较低。通过使用针对老年患者优化的hs-cTnI阈值，可以改善这种较低的特异性。