Abstract Aims To directly compare the diagnostic accuracy of high-sensitivity cardiac troponin (hs-cTn) T vs. hs-cTnI in the early non-invasive differentiation of Type 1 myocardial infarction (T1MI) due to plaque rupture and atherothrombosis from Type 2 myocardial infarction (T2MI) due to supply–demand mismatch. Methods and results In a prospective multicentre diagnostic study, two independent cardiologists centrally adjudicated the final diagnosis of T1MI vs. T2MI according to the fourth universal definition of myocardial infarction (MI), using all available clinical information including cardiac imaging in patients presenting with acute chest pain. Diagnostic accuracy was quantified by the area under the receiver operating characteristics curve (AUC). The most extensively validated hs-cTnT-Elecsys and hs-cTnI-Architect assays were measured at presentation, 1 h, and 2 h. Among 5887 patients, 1106 (19%) had a final diagnosis of MI, including 860 (78%) T1MI and 246 (22%) T2MI. The AUC of hs-cTnT-Elecsys to differentiate T1MI from T2MI was moderate and comparable to that provided by hs-cTnI-Architect: hs-cTnT-Elecsys AUC-presentation 0.67 [95% confidence interval (CI) 0.64–0.71], AUC-1 h 0.70 (95% CI 0.66–0.74), and AUC-2 h 0.71 (95% CI 0.66–0.75) vs. hs-cTnI-Architect AUC-presentation 0.71 (95% CI 0.67–0.74), AUC-1 h 0.72 (95% CI 0.68–0.76), and AUC-2 h 0.74 (95% CI 0.69–0.78), all P = not significant (NS). Similarly, the AUC of absolute changes was moderate and comparable for hs-cTnT-Elecsys and hs-cTnI-Architect (all P = NS). Cut-off concentrations achieving at least 90% specificity for the differentiation of T1MI vs. T2MI were >114 ng/L for hs-cTnT-Elecsys [odds ratio (OR) 4.2, 95% CI 2.7–6.6] and >371 ng/L for hs-cTnI-Architect (OR 4.0, 95% CI 2.6–6.2). Conclusion hs-cTnT-Elecsys and hs-cTnI-Architect provided comparable, albeit only moderate, diagnostic accuracy for the early differentiation of T1MI vs. T2MI. Clinical trial registration ClinicalTrials.gov number, NCT00470587, https://clinicaltrials.gov/ct2/show/NCT00470587.

中文翻译：

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高敏心肌肌钙蛋白 T 和 I 在 1 型与 2 型心肌梗死早期鉴别中的直接比较

摘要 目标直接比较高敏心肌肌钙蛋白 (hs-cTn) T 与 hs-cTnI 在早期无创鉴别由于 2 型心肌梗死斑块破裂和动脉粥样硬化血栓形成而导致的 1 型心肌梗死 (T1MI) 中的诊断准确性（ T2MI）由于供需不匹配。 方法和结果在一项前瞻性多中心诊断研究中，两名独立心脏病专家根据心肌梗死 (MI) 的第四个通用定义，使用包括急性胸痛患者心脏影像在内的所有可用临床信息，集中裁定 T1MI 与 T2MI 的最终诊断。诊断准确性通过受试者工作特征曲线下面积 (AUC) 进行量化。最广泛验证的 hs-cTnT-Elecsys 和 hs-cTnI-Architect 检测在演示时、1 小时和 2 小时进行测量。在 5887 名患者中，1106 名（19%）最终诊断为 MI，其中 860 名（78%）T1MI 和 246 名（22%）T2MI。hs-cTnT-Elecsys 区分 T1MI 和 T2MI 的 AUC 适中，与 hs-cTnI-Architect 提供的 AUC 相当：hs-cTnT-Elecsys AUC-presentation 0.67 [95% 置信区间 (CI) 0.64–0.71]，AUC -1 小时 0.70 (95% CI 0.66–0.74) 和 AUC-2 小时 0.71 (95% CI 0.66–0.75) 与 hs-cTnI-Architect AUC 呈现 0.71 (95% CI 0.67–0.74)、AUC-1 h 0.72 (95% CI 0.68–0.76)，AUC-2 h 0.74 (95% CI 0.69–0.78)，所有 P = 不显着 (NS)。同样，hs-cTnT-Elecsys 和 hs-cTnI-Architect 的绝对变化 AUC 适中且具有可比性（所有 P = NS）。hs-cTnT-Elecsys 达到至少 90% 区分 T1MI 与 T2MI 特异性的截止浓度为 > 114 ng/L [比值比 (OR) 4.2，95% CI 2.7–6.6] 且 > 371 hs-cTnI-Architect 为 ng/L（OR 4.0，95% CI 2.6–6.2）。 结论hs-cTnT-Elecsys 和 hs-cTnI-Architect 为 T1MI 与 T2MI 的早期区分提供了可比的（尽管中等）诊断准确性。 临床试验注册ClinicalTrials.gov 编号，NCT00470587，https://clinicaltrials.gov/ct2/show/NCT00470587。