一项双盲、多中心研究，比较诊断标志物预测短期和长期临床事件的准确性及其在胸痛患者中的效用。

A double-blind, multicentered study comparing the accuracy of diagnostic markers to predict short- and long-term clinical events and their utility in patients presenting with chest pain.

作者信息

Fromm R, Meyer D, Zimmerman J, Boudreaux A, Wun C C, Smalling R, Davis B, Habib G, Roberts R

机构信息

Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.

出版信息

Clin Cardiol. 2001 Jul;24(7):516-20. doi: 10.1002/clc.4960240708.

DOI:10.1002/clc.4960240708

PMID:11444643

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6654932/

Abstract

BACKGROUND

Millions of patients present annually with chest pain, but only 10% have myocardial infarction (MI). We recently reported comparative sensitivity and specificity of available markers in the diagnosis of MI; however, optimum interpretation of marker results requires prognostic follow-up data.

HYPOTHESIS

The study was undertaken to study the accuracy of CK-MB subforms, troponin I and T, myoglobin, and CK-MB in predicting clinical events at 30 days and 6 months.

METHODS

In all, 955 consecutive patients with chest pain were enrolled in a prospective, multicenter, double-blind study to test the prognostic accuracy of these markers.

RESULTS

Myocardial infarction was diagnosed in 119 by CK-MB mass criteria and unstable angina (UA) in 203 patients by clinical criteria. Follow-up at 30 days and 6 months was available in 824 and 724 patients, respectively, with mortalities of 2.8 and 4.14%, respectively. Cumulative 6-month mortality was 5.6% in MI, 4.4% in UA, and 3.0% in others. Revascularization was reported in 9.3% of patients by 6 months. A positive test on each of the markers except myoglobin was predictive of revascularization. The composite endpoint of death or revascularization occurred in 107 patients by 6 months and a positive result on each of the markers was predictive of this composite endpoint (p < 0.05). The relative risk of death or revascularization for patients who did not have MI but tested positive on each of the markers was > 1.0 but did not reach statistical significance.

CONCLUSIONS

With the possible exception of myoglobin, each of the diagnostic markers displayed similar prognostic performance in patients with chest pain presenting to emergency departments. The most appropriate markers to triage patients with chest pain, which has both adequate early diagnostic sensitivity and prognostic accuracy, are the CK-MB subforms.

摘要

背景

每年有数百万患者出现胸痛症状，但仅有10%患有心肌梗死（MI）。我们最近报道了现有标志物在MI诊断中的比较敏感性和特异性；然而，对标志物结果的最佳解读需要预后随访数据。

假设

本研究旨在探讨肌酸激酶同工酶（CK-MB）亚型、肌钙蛋白I和T、肌红蛋白以及CK-MB在预测30天和6个月临床事件方面的准确性。

方法

总共955例连续胸痛患者被纳入一项前瞻性、多中心、双盲研究，以测试这些标志物的预后准确性。

结果

根据CK-MB质量标准诊断出119例心肌梗死，根据临床标准诊断出203例不稳定型心绞痛（UA）患者。分别有824例和724例患者获得了30天和6个月的随访，死亡率分别为2.8%和4.14%。MI患者6个月累计死亡率为5.6%，UA患者为4.4%，其他患者为3.0%。到6个月时，9.3%的患者进行了血运重建。除肌红蛋白外，其他每种标志物检测呈阳性均提示血运重建。到6个月时，107例患者出现了死亡或血运重建的复合终点，每种标志物检测呈阳性均提示该复合终点（p<0.05）。未患MI但每种标志物检测均呈阳性的患者发生死亡或血运重建的相对风险>1.0，但未达到统计学显著性。