Walter S, Carlsson J, Cuneo A, Tebbe U
Medizinische Klinik II, Klinikum Lippe-Detmold.
Dtsch Med Wochenschr. 2001 Jul 6;126(27):771-8. doi: 10.1055/s-2001-15559.
The acute coronary syndrome (ACS)--acute infarction or unstable angina pectoris--requires special monitoring and differentiated treatment. A prospective trial was undertaken to determine (1) clinical characteristics of patients with chest pain; (2) value of cardiac markers troponin T, myoglobin and CK-MB mass in differentiating cardiac and noncardiac chest pain; (3) the proportion of patients with ACS in whom these markers provided helpful additional information on admission and afterwards.
233 consecutive patients (134 men, 99 women; aged 18-98 years), presenting in 1998 with nontraumatic chest pain at the emergency unit of the Lippe-Detmold Hospital were prospectively enrolled in the study. Levels of troponin T, myoglobin, CK-MB mass and activity and creatine kinase were measured on admission and after 2, 4 and 12-24 hours.
ACS was ultimately diagnosed in 73 patients (31%). These were significantly older (p = 0.0015) and more often male (p = 0.046). 91% of patients with ACS but only 68% of those without described the chest pain as a sense of pressure or stabbing (p = 0.0002). Measurement of troponin T and myoglobin on admission was helpful in 39% of those with ACS, compared with 15% of those without. When the admission ECG was normal or nonspecific in patients with ACS, troponin T was elevated in 16%, CK-MB mass in 24%. In patients with unstable angina no single marker was associated with an increased risk (high rate of special supervision and intervention).
In the assessment of patients with acute chest pain clinical judgement plays the predominant role. In the mostly elderly and male patients with ACS (31% of the cohort) feeling of pressure or stabbing chest pain were most prominent (91%). Cardiac markers troponin T, CK-MB mass and myoglobin were helpful in the differential diagnosis of chest pain, even when the ECG was unremarkable or nonspecific. At the time of admission myoglobin was the most significant marker for acute myocardial infarction or unstable angina.
急性冠状动脉综合征（ACS）——急性心肌梗死或不稳定型心绞痛——需要特殊监测和个体化治疗。开展了一项前瞻性试验，以确定：（1）胸痛患者的临床特征；（2）心肌标志物肌钙蛋白T、肌红蛋白和肌酸激酶同工酶质量在鉴别心源性和非心源性胸痛中的价值；（3）这些标志物在入院时及之后为ACS患者提供有用补充信息的比例。
1998年在利普-德特莫尔德医院急诊科因非创伤性胸痛就诊的233例连续患者（134例男性，99例女性；年龄18 - 98岁）被前瞻性纳入研究。入院时以及2、4和12 - 24小时后测定肌钙蛋白T、肌红蛋白、肌酸激酶同工酶质量和活性以及肌酸激酶水平。
最终73例患者（31%）被诊断为ACS。这些患者年龄显著更大（p = 0.0015），男性比例更高（p = 0.046）。91%的ACS患者将胸痛描述为压榨感或刺痛感，而无ACS的患者中这一比例仅为68%（p = 0.0002）。入院时测定肌钙蛋白T和肌红蛋白对39%的ACS患者有帮助，而对无ACS的患者这一比例为15%。当ACS患者入院心电图正常或不具有特异性时，16%的患者肌钙蛋白T升高，24%的患者肌酸激酶同工酶质量升高。在不稳定型心绞痛患者中，没有单一标志物与风险增加相关（特殊监测和干预率高）。
在评估急性胸痛患者时，临床判断起主要作用。在大多数为老年男性的ACS患者（占队列的31%）中，压榨感或刺痛感胸痛最为突出（91%）。心肌标志物肌钙蛋白T、肌酸激酶同工酶质量和肌红蛋白在胸痛的鉴别诊断中有用，即使心电图无异常或不具有特异性。入院时，肌红蛋白是急性心肌梗死或不稳定型心绞痛的最重要标志物。
