Jurlander B, Clemmensen P, Wagner G S, Grande P
The Heart Center, H:S Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Eur Heart J. 2000 Mar;21(5):382-9. doi: 10.1053/euhj.1999.1760.
The diagnostic and prognostic capacity of biochemical markers of acute myocardial infarction in the emergency department were evaluated in consecutive patients (n=155) with suspected acute myocardial infarction.
Serum myoglobin >/=110 microg. l(-1)and creatine kinase MB(mass)>/=5 microg. l(-1)had a high accuracy (0.77-0.85) (ns) for acute myocardial infarction diagnosis in patients presenting >2 h after symptom onset. Troponin-T (>/=0.10 microg. l(-1)) had a lower accuracy (0.53-0.70) for acute myocardial infarction diagnosis, but was the most important 1-year prognostic marker (cardiac death or non-fatal acute myocardial infarction). In patients without ST elevation, combined analysis of two biochemical tests would accurately identify an additional 20% of acute myocardial infarction patients (predictive value of a positive test=0.82) and also identify those without acute myocardial infarction (predictive value of a negative test=0.80). One-year event-free survival was excellent (96%) for patients with two negative biochemical tests, intermediate (74%) for those with discordant tests, and only 53% for patients with two positive biochemical tests.
Analysis of biochemical tests in the emergency department prior to hospital admission could accurately identify approximately 20% additional acute myocardial infarction patients. The prognosis of these patients is poor, and they may be a target for primary PTCA or new early initiated aggressive medical therapies.
对连续收治的155例疑似急性心肌梗死患者，评估急诊科急性心肌梗死生化标志物的诊断和预后能力。
症状出现2小时后就诊的患者中，血清肌红蛋白≥110μg·l⁻¹和肌酸激酶同工酶MB（质量法）≥5μg·l⁻¹对急性心肌梗死诊断具有较高准确性（0.77 - 0.85）（无显著差异）。肌钙蛋白T（≥0.10μg·l⁻¹）对急性心肌梗死诊断准确性较低（0.53 - 0.70），但它是最重要的1年预后标志物（心脏死亡或非致死性急性心肌梗死）。在无ST段抬高的患者中，两项生化检测联合分析可准确识别另外20%的急性心肌梗死患者（阳性检测预测值 = 0.82），并能识别无急性心肌梗死的患者（阴性检测预测值 = 0.80）。两项生化检测均为阴性的患者1年无事件生存率极佳（96%），检测结果不一致的患者为中等（74%），两项生化检测均为阳性的患者仅为53%。
入院前在急诊科进行生化检测分析可准确识别约20%更多的急性心肌梗死患者。这些患者预后较差，可能是直接经皮冠状动脉腔内血管成形术或新的早期积极药物治疗的目标人群。
