摘要：

急性胸痛患者早期诊断急性心肌梗死(AMI)可提高临床疗效。此外，在急诊科资源有限的情况下，迅速排除急性心肌梗塞对患者的分诊非常重要。高灵敏度心肌肌钙蛋白(hs-cTn)检测在世界许多国家得到越来越多的应用;然而，目前还没有一个普遍接受的高灵敏度的定义。这些检测方法使cTn测量具有高度的分析灵敏度，在cTn测定的低测量范围内具有低的分析不精密度(在第99个百分位上参考限值的变异系数< 8 10%)。AMI.1与敏感肌钙蛋白测定相比，高敏感肌钙蛋白测定提高了诊断的准确性和速度，1- 4改善了预后，且成本效益高最近的研究表明，当低于99个百分位数的值作为截止值时，AMI可以在3小时之前诊断出来。这一概念被纳入2015年欧洲心脏病学会NSTEMI指南，作为标准方法的替代方案。8we aimed to develop an algorithm for accurate and rapid exclusion and diagnosis of AMI after 1 hour using a cutoff below the 99th percentile and compare it with the recommended 3-hour approach. One of the most important advantages of these new assays is that they allow novel, more rapid approaches to rule in or rule out acute coronary syndromes (ACSs) than with previous cTn assay generations which are still more commonly used in practice worldwide. hs-cTn is also more sensitive for the detection of myocardial damage unrelated to acute myocardial ischemia. Therefore, the increase in early diagnostic sensitivity of hs-cTn assays for ACS comes at the cost of a reduced ACS specificity, because more patients with other causes of acute or chronic myocardial injury without overt myocardial ischemia are detected than with previous cTn assays. As hs-cTn assays are increasingly being adopted in clinical practice and more hs-cTn assays are being developed, this review attempts to synthesize the available clinical data to make recommendations for their everyday clinical routine use.