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Kardiales Troponin und mehr beim akuten Koronarsyndrom

Cardiac troponins and beyond in acute coronary syndrome

  • Schwerpunkt: Biomarker in der Akutmedizin
  • Published:
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Zusammenfassung

Kardiale Biomarker sind essenzieller Bestandteil der Diagnostik des akuten Koronarsyndroms (ACS). Kardiales Troponin (cTn) ist der sensitivste diagnostische Biomarker beim ACS und erlaubt die Abgrenzung des akuten Nicht-ST-Strecken-Hebungs-Infarkts (NSTEMI) von der instabilen Angina. Bei der Abklärung akuter Thoraxschmerzen müssen sämtliche kardialen und nichtkardialen Differenzialdiagnosen berücksichtigt werden. Neben dem ACS hat cTn auch bei einer Vielzahl anderer Krankheitsbilder eine prognostische Bedeutung. Bevorzugt sollten hochsensitive cTn(hsTn)-Assays eingesetzt werden. Mit Point-of-care(POC)-Troponintests ist in der Regel ein Nachweis („rule-in“), jedoch kein zuverlässiger Ausschluss („rule-out“) des akuten Myokardinfarkts (MI) möglich, da die meisten POC-cTn-Assays über keine ausreichende diagnostische Sensitivität verfügen. Neuere Assays könnten diese Limitation überwinden. Für den Ausschluss des MI mit hsTn-Assays existieren diverse Protokolle. Bei Verwendung von hsTn-Assays kann je nach Protokoll bereits bei Aufnahme mit oder ohne zusätzlicher Bestimmung von Copeptin nach 1, 2 oder 3 h ein MI ausgeschlossen werden. In diesem Beitrag werden Protokolle und Leitlinienempfehlungen zur Infarktdiagnostik dargestellt. Dabei wird im Besonderen auf die Rolle von POC-Troponinassays eingegangen.

Abstract

Cardiac biomarkers are an integral component of the diagnostic work-up of patients with suspected acute coronary syndrome (ACS). Cardiac troponin (cTn) is the most sensitive diagnostic biomarker for patients with ACS and enables the differentiation of acute non-ST-elevation myocardial infarction (NSTEMI) from unstable angina. All cardiac and non-cardiac differential diagnoses must be taken into consideration. The use of cTn has a prognostic value in a multitude of acute and chronic diseases apart from ACS. Highly sensitive cTn (hsTn) assays should be preferentially used. Point-of-care (POC) troponin assays can be used for rule-in of acute MI but are generally not useful for rule-out of MI due to their lack of sensitivity compared to hsTn assays. This, however, may change with recent developments of newer and improved POC troponin assays. For exclusion of MI using hsTn assays, there are various protocols available, such as the instant rule-out with undetectable hsTn levels at admission or normal hsTn/cTn levels combined with normal copeptin levels or rule-out with serial controls of hsTn after 1, 2 or 3 h. This article provides an overview of guideline-recommended rule-out protocols for patients with suspected ACS and discusses recent advances in POC troponin assays.

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Authors and Affiliations

  1. Medizinische Klinik III, Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland

    M. Vafaie,  K. M. Stoyanov,  H. A. Katus &  E. Giannitsis

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  1. M. Vafaie
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  2. K. M. Stoyanov
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  3. H. A. Katus
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  4. E. Giannitsis
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Correspondence to E. Giannitsis.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: M. Vafaie hat finanzielle Unterstützung für klinische Studien von Bayer Healthcare Germany und Daiichi Sankyo erhalten. Ihm wurden Reisekosten und Teilnahmegebühren für Fortbildungsveranstaltungen erstattet von Roche Diagnostics und BRAHMS. K.M. Stoyanov gibt an, dass kein Interessenkonflikt besteht. H.A. Katus hat den kardialen Troponin-T-Test entwickelt und hielt hierfür gemeinsam mit Roche Diagnostics ein Patent bis zu dessen Ablauf. Er hat Förderungen von mehreren Firmen erhalten und war als Referent für die Firma Roche Diagnostics tätig. E. Giannitsis hat finanzielle Unterstützung für klinische Studien erhalten von Roche Diagnostics Ltd., Schweiz, Mitsubishi Chemicals, Deutschland, Siemens Healthcare, BRAHMS Biomarkers, Clinical Diagnostics Division, Thermo Fisher Scientific, Deutschland. Er ist Berater von Roche Diagnostics und BRAHMS Biomarkers und hat Vortragshonorare von Roche Diagnostics, Siemens Healthcare, BRAHMS Biomarkers und Mitsubishi Chemicals erhalten.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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G. Hasenfuß, Göttingen

S. von Haehling, Göttingen

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Vafaie, M., Stoyanov, K.M., Katus, H.A. et al. Kardiales Troponin und mehr beim akuten Koronarsyndrom. Internist 60, 555–563 (2019). https://doi.org/10.1007/s00108-019-0611-x

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  • DOI: https://doi.org/10.1007/s00108-019-0611-x

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