Duca M D, Giri S, Wu A H, Morris R S, Cyr G M, Ahlberg A, White M, Waters D D, Heller G V
Department of Medicine, University of Connecticut School of Medicine, Farmington 06102, USA.
J Nucl Cardiol. 1999 Nov-Dec;6(6):570-6. doi: 10.1016/s1071-3581(99)90092-2.
Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-cardiac causes.
Serum markers and acute technetium-99m sestamibi/tetrofosmin rest MPI were obtained in 75 patients admitted to the ED with chest pain and nondiagnostic electrocardiograms. Venous samples were drawn at admission and 8 to 24 hours later for total creatine kinase, CK-MB fraction, troponin T, troponin I, and myoglobin. Three nuclear cardiologists performed blinded image interpretation. Coronary artery disease (CAD) was confirmed either by diagnostic testing or by the occurrence of myocardial infarction (MI).
Acute rest MPI results were abnormal in all 9 patients with MI. An additional 26 patients had objective evidence of CAD confirmed by diagnostic testing. The sensitivity of acute rest MPI for objective evidence of CAD was 73%. Serum troponin T and troponin I were highly specific for acute MI but had low sensitivity at presentation. Individual serum markers had very low sensitivity for symptomatic myocardial ischemia alone. In the multivariate regression model, only acute rest MPI and diabetes were independently predictive of CAD.
At the time of presentation and 8 to 24 hours later, acute rest MPI has a better sensitivity and similar specificity for patients with objective evidence of CAD when compared with serum markers.
诸如血清标志物和急性静息心肌灌注成像（MPI）等新型诊断方法已在急诊科（ED）胸痛患者中进行了诊断评估，但从未同时进行过评估。我们比较了这两种方法在区分急诊科有症状性心肌缺血患者和非心脏原因患者方面的差异。
对75例因胸痛入院且心电图无诊断意义的患者进行了血清标志物检测和急性锝-99m司他米比/替曲膦静息MPI检查。入院时及8至24小时后采集静脉血样，检测总肌酸激酶、肌酸激酶同工酶MB、肌钙蛋白T、肌钙蛋白I和肌红蛋白。三位核心脏病专家对图像进行了盲法解读。通过诊断性检查或心肌梗死（MI）的发生来确诊冠状动脉疾病（CAD）。
所有9例MI患者的急性静息MPI结果均异常。另外26例患者通过诊断性检查确诊有CAD的客观证据。急性静息MPI对CAD客观证据的敏感性为73%。血清肌钙蛋白T和肌钙蛋白I对急性MI具有高度特异性，但在发病时敏感性较低。单独的血清标志物对有症状性心肌缺血的敏感性非常低。在多变量回归模型中，只有急性静息MPI和糖尿病可独立预测CAD。
与血清标志物相比，在就诊时及8至24小时后，急性静息MPI对有CAD客观证据的患者具有更好的敏感性和相似的特异性。
