Cardiac troponins have replaced creatine kinase-MB as the preferred biomarker for establishing the diagnosis of myocardial infarction (MI). Expert recommendations set the diagnostic decision-limit for each assay at the 99th percentile of troponin levels in an apparently healthy reference population, which due to a lack of standardization, will vary depending upon the manufacturer. Among patients presenting with an acute coronary syndrome (ACS), even low-level elevations of cardiac troponin T or I correlate with higher risk of death and recurrent ischemic events compared to patients with levels of troponin below the decision limit. Renal failure does not appear to diminish the prognostic value of troponins among patients with a high clinical probability of ACS. Moreover, patients with elevated levels of troponin derive the most benefit from more intense medical therapy with antithrombin and antiplatelet medications, as well as an early invasive management strategy. Whereas cardiac troponins are extremely specific for myocardial necrosis, they do not discriminate between ischemic and non-ischemic etiologies of myocardial injury. Clinicians must, therefore, determine whether a patient's presenting symptoms are consistent with ACS. Combining troponin with other cardiac biomarkers may offer complimentary information on the underlying pathobiology and prognosis in an individual patient. Future generations of troponin assays may detect specific posttranslational modifications of troponins that may increase the analytic sensitivity for myocardial damage and offer insight into the timing and mechanism of myocardial injury.

中文翻译：

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肌钙蛋白在急性冠脉综合征中。

心肌肌钙蛋白已取代肌酸激酶-MB，成为建立心肌梗死（MI）诊断的首选生物标志物。专家的建议将每个测定的诊断决策极限设定在表面上健康的参考人群中肌钙蛋白水平的第99个百分位数，由于缺乏标准化，这将取决于制造商。在患有急性冠状动脉综合征（ACS）的患者中，与肌钙蛋白水平低于决策极限的患者相比，即使心肌肌钙蛋白T或I的低水平升高也与更高的死亡风险和复发性缺血事件相关。肾衰竭似乎并未降低肌钙蛋白在具有ACS临床可能性的患者中的预后价值。此外，肌钙蛋白水平升高的患者从抗凝血酶和抗血小板药物的更深入的药物治疗以及早期侵入性治疗策略中获得最大收益。尽管心肌肌钙蛋白对心肌坏死具有极高的特异性，但它们不能区分心肌损伤的缺血性和非缺血性病因。因此，临床医生必须确定患者出现的症状是否与ACS一致。肌钙蛋白与其他心脏生物标志物的组合可提供有关个体患者潜在病理生物学和预后的补充信息。