Green G B, Skarbek-Borowski G W, Chan D W, Kelen G D
Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287-2080, USA.
Acad Emerg Med. 2000 Jun;7(6):625-36. doi: 10.1111/j.1553-2712.2000.tb02035.x.
To determine and compare the prognostic abilities of early, single-sample myoglobin measurement with that of creatine kinase-MB (CK-MB), with cardiac troponin T (cTnT), and with physician judgment in the absence of marker results among emergency department (ED) patients with possible myocardial ischemia.
Prospective collection of clinical and serologic data using an identity-unlinked technique from patients with possible myocardial ischemia at two urban EDs. Outcome data concerning the occurrence of adverse events (AEs) during the 14 days after enrollment were used to calculate and compare the relative risks (RRs) and predictive values (with 95% confidence intervals) of the various markers for predicting AEs.
Among 396 analyzed patients, 65 (16.4%) accrued 104 AEs, including 13 deaths (3.3%) and 31 (7.8%) myocardial infarctions. Myoglobin predicted AEs (RR = 3.36 [95% CI = 2.19 to 5.15]) with significantly higher sensitivity (50.8% [95% CI = 38.6 to 62.9]) than either CK-MB (15.4% [95% CI = 6.6 to 24.2]) or cTnT (24.6% [95% CI = 14.1 to 35.1]), but with lower specificity (81.9% [95% CI = 77.7 to 86.0]; CK-MB = 99.7% [95% CI = 99.1 to 100]; cTnT = 93.1% [95% CI = 90.3 to 95.8]). Myoglobin had prognostic ability among patients with chest pain (3.86 [95% CI = 2.39 to 6.22]) and atypical (non-chest pain) presentations (2.71 [95% CI = 1.09 to 6.71]), including those with a nondiagnostic electrocardiogram (3.11 [95% CI = 1.44 to 6.69]). The combination of myoglobin and physician decision making identified 63 of the 65 patients (96.9% [95% CI = 92.7 to 100]) with subsequent AEs.
The early prognostic sensitivity of myoglobin may allow identification of some high-risk patients missed by physician judgment, CK-MB, and cTnT. Myoglobin should be considered for use in the ED based on both its diagnostic and prognostic abilities.
在可能发生心肌缺血的急诊科（ED）患者中，确定并比较早期单样本肌红蛋白测量值与肌酸激酶-MB（CK-MB）、心肌肌钙蛋白T（cTnT）的预后评估能力，以及在无标志物检测结果时医生判断的预后评估能力。
采用身份无关技术前瞻性收集两家城市急诊科可能发生心肌缺血患者的临床和血清学数据。使用入组后14天内不良事件（AE）发生情况的结局数据来计算并比较各种标志物预测AE的相对风险（RR）和预测值（95%置信区间）。
在396例分析患者中，65例（16.4%）发生了104次AE，包括13例死亡（3.3%）和31例（7.8%）心肌梗死。肌红蛋白预测AE（RR = 3.36 [95% CI = 2.19至5.15]），其敏感性（50.8% [95% CI = 38.6至62.9]）显著高于CK-MB（15.4% [95% CI = 6.6至24.2]）或cTnT（24.6% [95% CI = 14.1至35.1]），但特异性较低（81.9% [95% CI = 77.7至86.0]；CK-MB = 99.7% [95% CI = 99.1至100]；cTnT = 93.1% [95% CI = 90.3至95.8]）。肌红蛋白在胸痛患者（3.86 [95% CI = 2.39至6.22]）和非典型（非胸痛）表现患者（2.71 [95% CI = 1.09至6.71]）中具有预后评估能力，包括心电图无诊断意义的患者（3.11 [95% CI = 1.44至6.69]）。肌红蛋白与医生判断相结合可识别出65例中有63例（96.9% [95% CI = 92.7至100]）随后发生AE的患者。
肌红蛋白的早期预后敏感性可能有助于识别一些被医生判断、CK-MB和cTnT漏诊的高危患者。基于其诊断和预后评估能力，急诊科应考虑使用肌红蛋白。
