Gibler W B, Hoekstra J W, Weaver W D, Krucoff M W, Hallstrom A P, Jackson R E, Sayre M R, Christenson J, Higgins G L, Innes G, Harper R J, Young G P, Every N R
University of Cincinnati College of Medicine, Ohio 45267-0769, USA.
J Am Coll Cardiol. 2000 Nov 1;36(5):1500-6. doi: 10.1016/s0735-1097(00)00897-4.
The purpose of this study was to assess whether the immediate availability of serum markers would increase the appropriate use of thrombolytic therapy.
Serum markers such as myoglobin and creatine kinase, MB fraction (CK-MB) are effective in detecting acute myocardial infarction (AMI) in the emergency setting. Appropriate candidates for thrombolytic therapy are not always identified in the emergency department (ED), as 20% to 30% of eligible patients go untreated, representing 10% to 15% of all patients with AMI. Patients presenting with chest pain consistent with acute coronary syndrome were evaluated in the EDs of 12 hospitals throughout North America.
In this randomized, controlled clinical trial, physicians received either the immediate myoglobin/CK-MB results at 0 and 1 h after enrollment (stat) or conventional reporting of myoglobin/CK-MB 3 h or more after hospital admission (control). The primary end point was the comparison of the proportion of patients within the stat group versus control group who received appropriate thrombolytic therapy. Secondary end points included the emergent use of any reperfusion treatment in both groups, initial hospital disposition of patients (coronary care unit, monitor or nonmonitor beds) and the proportion of patients appropriately discharged from the ED.
Of 6,352 patients enrolled, 814 (12.8%) were diagnosed as having AMI. For patients having AMI, there were no statistically significant differences in the proportion of patients treated with thrombolytic therapy between the stat and control groups (15.1% vs. 17.1%, p = 0.45). When only patients with ST segment elevation on their initial electrocardiogram were compared, there were still no significant differences between the groups. Also, there was no difference in the hospital placement of patients in critical care and non- critical care beds. The availability of early markers was associated with more hospital admissions as compared to the control group, as the number of patients discharged from the ED was decreased in the stat versus control groups (28.4% vs. 31.5%, p = 0.023).
The availability of 0- and 1-h myoglobin and CK-MB results after ED evaluation had no effect on the use of thrombolytic therapy for patients presenting with AMI, and it slightly increased the number of patients admitted to the hospital who had no evidence of acute myocardial necrosis.
本研究旨在评估血清标志物的即时可得性是否会增加溶栓治疗的合理应用。
肌红蛋白和肌酸激酶同工酶（CK-MB）等血清标志物在急诊环境中检测急性心肌梗死（AMI）方面有效。在急诊科（ED）并非总能识别出适合溶栓治疗的患者，因为20%至30%的符合条件的患者未接受治疗，占所有AMI患者的10%至15%。在北美12家医院的急诊科对表现为符合急性冠状动脉综合征胸痛的患者进行了评估。
在这项随机对照临床试验中，医生在入组后0小时和1小时接受即时肌红蛋白/CK-MB结果（即时组），或在入院3小时或更晚后接受肌红蛋白/CK-MB的常规报告（对照组）。主要终点是比较即时组与对照组中接受适当溶栓治疗的患者比例。次要终点包括两组中任何再灌注治疗的紧急使用情况、患者的初始医院处置（冠心病监护病房、监测或非监测病床）以及从急诊科适当出院的患者比例。
在6352名入组患者中，814名（12.8%）被诊断为AMI。对于患有AMI的患者，即时组和对照组之间接受溶栓治疗的患者比例无统计学显著差异（15.1%对17.1%，p = 0.45）。当仅比较初始心电图有ST段抬高的患者时，两组之间仍无显著差异。此外，患者在重症监护和非重症监护病床的医院安置情况也无差异。与对照组相比，早期标志物的可得性与更多的住院人数相关，因为即时组与对照组相比从急诊科出院的患者数量减少（28.4%对31.5%，p = 0.023）。
急诊评估后0小时和1小时的肌红蛋白和CK-MB结果的可得性对AMI患者溶栓治疗的使用没有影响，并且略微增加了入院但无急性心肌坏死证据的患者数量。
