Kontos Michael C, Anderson F Philip, Ornato Joseph P, Tatum James L, Jesse Robert L
Department of Internal Medicine, Cardiology Division, Virginia Commonwealth University, Medical College of Virginia Hospitals, Richmond, VA, USA.
Acad Emerg Med. 2002 Oct;9(10):1007-13. doi: 10.1111/j.1553-2712.2002.tb02134.x.
Baseline electrocardiogram abnormalities and market elevations not associated with myocardial necrosis make accurate diagnosis of myocardial infarction (MI) difficult in patients with cocaine-associated chest pain. Troponin sampling may offer greater diagnostic utility in these patients.
To assess outcomes based on troponin positivity in patients with cocaine chest pain admitted for exclusion of MI.
Outcomes were examined in patients admitted for possible MI after cocaine use. All patients underwent a rapid rule-in protocol that included serial sampling of creatine kinase (CK), CK-MB, and cardiac troponin I (cTnI) over eight hours. Outcomes included CK-MB MI (CK-MB >or= 8 ng/mL with a relative index [(CK-MB x 100)/total CK] >or= 4, cardiac death, and significant coronary disease (>or=50%).
Of the 246 admitted patients, 34 (14%) met CK-MB criteria for MI and 38 (16%) had cTnI elevations. Angiography was performed in 29 of 38 patients who were cTnI-positive, with significant disease present in 25 (86%). Three of the four patients without significant disease who had cTnI elevations met CK-MB criteria for MI, and the other had a peak CK-MB level of 13 ng/mL. Sensitivities, specificities, and positive and negative likelihood ratios for predicting cardiac death or significant disease were high for both CK-MB MI and cTnI and were not significantly different.
Most patients with cTnI elevations meet CK-MB criteria for MI, as well as have a high incidence of underlying significant disease. Troponin appears to have an equivalent diagnostic accuracy compared with CK-MB for diagnosing necrosis in patients with cocaine-associated chest pain and suspected MI.
基线心电图异常和与心肌坏死无关的肌酸激酶升高使得对可卡因相关性胸痛患者的心肌梗死（MI）进行准确诊断变得困难。肌钙蛋白检测可能对这些患者具有更大的诊断价值。
评估因排除MI而入院的可卡因相关性胸痛患者中肌钙蛋白阳性的预后情况。
对因使用可卡因后可能发生MI而入院的患者的预后情况进行检查。所有患者均接受快速确诊方案，包括在8小时内对肌酸激酶（CK）、CK-MB和心肌肌钙蛋白I（cTnI）进行系列检测。预后情况包括CK-MB性MI（CK-MB≥8 ng/mL且相对指数[(CK-MB×100)/总CK]≥4）、心源性死亡和严重冠状动脉疾病（≥50%）。
在246例入院患者中，34例（14%）符合MI的CK-MB标准，38例（16%）cTnI升高。对38例cTnI阳性患者中的29例进行了血管造影，其中25例（86%）存在严重疾病。4例cTnI升高但无严重疾病的患者中有3例符合MI的CK-MB标准，另1例CK-MB峰值水平为13 ng/mL。CK-MB性MI和cTnI预测心源性死亡或严重疾病的敏感性、特异性以及阳性和阴性似然比均较高，且无显著差异。
大多数cTnI升高的患者符合MI的CK-MB标准，且潜在严重疾病的发生率较高。在诊断可卡因相关性胸痛且疑似MI的患者的心肌坏死方面，肌钙蛋白与CK-MB相比似乎具有同等的诊断准确性。
