The emergence of cardiac troponins has been an interesting step in the diagnosis of ACS. It has clearly helped us to better triage patients toward a more aggressive posture in performing early cardiac catheterization, and in some cases, early use of adjunctive Gp IIb/IIIa antagonists and percutaneous or surgical myocardial revascularization. However, with this step forward has come uncertainty and many cardiology consults regarding positive cardiac troponins in patients without ACS or myocardial infarction. In general, increased cardiac troponins imply a worse prognosis. This is clearly true of patients with ESRD and advanced heart failure. It is also true of patients with severe, noncardiac illnesses. In other situations, such as acute pericarditis and cardiac surgery, slightly elevated cardiac troponins do not seem to predict a worse prognosis, and can probably be disregarded. The elevation of cardiac troponins after successful percutaneous coronary interventions is not unexpected, and the level of cardiac troponin release seems to predict problems, but lively controversy persists. Last, monitoring cardiac troponins in cardiac transplant recipients and those receiving certain cardiotoxic chemotherapies may be of some diagnostic value, but clearly more experience and clinical research are needed.

中文翻译：

---

心肌肌钙蛋白在肾功能不全和其他非缺血性心脏病中的作用。

心肌肌钙蛋白的出现已成为ACS诊断中有趣的一步。显然，它有助于我们在进行早期心脏导管插入术（在某些情况下，及早使用辅助性Gp IIb / IIIa拮抗剂）以及经皮或外科手术心肌血运重建方面更好地将患者分流为更具侵略性的姿势。然而，随着这一进步的来临，不确定性不断提高，许多心脏病学专家就无ACS或心肌梗死的患者的心肌肌钙蛋白阳性进行了咨询。通常，心肌肌钙蛋白升高提示预后较差。ESRD和晚期心力衰竭患者显然是这样。患有严重的非心脏疾病的患者也是如此。在其他情况下，例如急性心包炎和心脏外科手术，心肌肌钙蛋白的升高似乎不能预示预后不良，并且可能被忽略。经皮冠状动脉介入治疗成功后，心肌肌钙蛋白的升高并不是意料之外的，心肌肌钙蛋白的释放水平似乎预示了问题，但仍存在激烈的争论。最后，监测心脏移植受者和接受某些心脏毒性化学疗法的人的肌钙蛋白可能具有一定的诊断价值，但显然需要更多的经验和临床研究。