Porela P, Pulkki K, Helenius H, Antila K J, Pettersson K, Wacker M, Voipio-Pulkki L M
Departments of Medicine, Clinical Chemistry, Biostatistics, Clinical Physiology, and Biotechnology, University of Turku, Turku, Finland.
Ann Emerg Med. 2000 May;35(5):413-20.
Although specific cardiac injury markers have enhanced early patient classification, the ECG remains a necessary investigation in the acute phase of chest pain. Combined use of both tests could further improve the diagnostic and prognostic accuracy.
We studied 311 consecutive patients who came to the emergency department of a regional referral hospital for the differential diagnosis of acute chest discomfort. The admission ECG was classified using an automated interpretation program and tested together with elevated admission creatine kinase isoform MB (CK-MB) and cardiac troponin I (TnI) concentration for prediction of final myocardial injury (44%) and in-hospital mortality (14%).
Combining the information from the admission ECG and cardiac markers, the sensitivity for becoming final myocardial injury (maximal CK-MB >/=11 microg/L) was 90% and specificity 61%. The proportion of false-negative results (10%) was independent of symptom duration. Age, positive ECG findings, and increased admission TnI levels were predictive for in-hospital mortality.
The commonly available biochemical and ECG criteria allow risk stratification of patients with a suspected acute ischemic event. The data analysis can easily be automated and is independent of patient delay.
尽管特定的心脏损伤标志物已改善了对患者的早期分类，但心电图在胸痛急性期仍是一项必要的检查。联合使用这两种检查可能会进一步提高诊断和预后准确性。
我们研究了311例连续因急性胸部不适前来地区转诊医院急诊科进行鉴别诊断的患者。入院心电图采用自动解读程序进行分类，并与升高的入院肌酸激酶同工酶MB（CK-MB）和心肌肌钙蛋白I（TnI）浓度一起进行检测，以预测最终心肌损伤（44%）和院内死亡率（14%）。
结合入院心电图和心脏标志物的信息，最终发生心肌损伤（最大CK-MB≥11μg/L）的敏感性为90%，特异性为61%。假阴性结果的比例（10%）与症状持续时间无关。年龄、心电图阳性结果和入院TnI水平升高可预测院内死亡率。
常用的生化和心电图标准可对疑似急性缺血事件的患者进行风险分层。数据分析可轻松实现自动化，且与患者延误无关。
