Mitchell Alice M, Garvey Joseph Lee, Kline Jeffrey A
Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC 28323-2861, USA.
Acad Emerg Med. 2006 Jul;13(7):803-6. doi: 10.1197/j.aem.2006.03.553. Epub 2006 May 24.
To test novel markers of acute coronary syndrome (ACS), monocyte chemoattractant protein-1 (MCP), myeloperoxidase (MPO), C-reactive protein (CRP), and brain natriuretic peptide (BNP) in low-risk emergency department (ED) patients who were evaluated for ACS in a chest pain unit (CPU).
A convenience sample of 414 patients underwent CPU evaluation, including provocative testing, and were followed prospectively for 45 days for ACS, which was defined as death, myocardial infarction (MI), revascularization, or >60% coronary artery stenosis prompting new medical treatment, adjudicated by three blinded reviewers. Published diagnostic thresholds were used to calculate diagnostic indices for each marker and for the multimarker panel.
The prevalence of ACS was 7 in 414 (1.7%; 95% CI = 0.7% to 3.5%). Only MCP demonstrated a negative likelihood ratio [LR(-)] of less than 0.5, with a sensitivity of 85% (95% CI = 42% to 99%), specificity of 72% (95% CI = 67% to 76%), and LR(-) of 0.20 (95% CI = 0.04 to 0.71). For MPO, CRP, and BNP, LR(-) was 0.89 (95% CI = 0.26 to 2.05), 0.79 (95% CI = 0.40 to 1.01), and 0.90 (95% CI = 0.51 to 1.03), respectively. The sensitivity, specificity, and LR(-) of an abnormal multimarker panel were 86% (95% CI = 42% to 100%), 17% (95% CI = 13% to 21%), and 0.84 (95% CI = 0.15 to 3.12), respectively.
The prevalence of ACS was very low but was similar to reports from other CPUs. BNP and CRP had high specificities, but had limited sensitivities, whereas MPO had a low specificity. Only MCP had a low LR(-) and should be studied further. The combined multimarker panel had an unexpectedly low sensitivity and specificity, yielding an LR(-) of 0.84, suggesting that the panel would not be an efficient screening test to decrease unnecessary CPU testing.
在胸痛单元（CPU）对因急性冠状动脉综合征（ACS）接受评估的低风险急诊科（ED）患者中，检测ACS的新型标志物，即单核细胞趋化蛋白-1（MCP）、髓过氧化物酶（MPO）、C反应蛋白（CRP）和脑钠肽（BNP）。
对414例患者进行便利抽样，接受CPU评估，包括激发试验，并前瞻性随访45天以观察ACS情况，ACS定义为死亡、心肌梗死（MI）、血运重建或冠状动脉狭窄>60%并因此开始新的药物治疗，由三位盲法评审员判定。采用已发表的诊断阈值来计算每个标志物以及多标志物组合的诊断指数。
414例患者中ACS的患病率为7例（1.7%；95%置信区间=0.7%至3.5%）。仅MCP的阴性似然比[LR(-)]小于0.5，其敏感性为85%（95%置信区间=42%至99%），特异性为72%（95%置信区间=67%至76%），LR(-)为0.20（95%置信区间=0.04至0.71）。对于MPO、CRP和BNP，LR(-)分别为0.89（95%置信区间=0.26至2.05）、0.79（95%置信区间=0.40至1.01）和0.90（95%置信区间=0.51至1.03）。异常多标志物组合的敏感性、特异性和LR(-)分别为86%（95%置信区间=42%至100%）、17%（95%置信区间=13%至21%）和0.84（95%置信区间=0.15至3.12）。
ACS的患病率非常低，但与其他CPU的报告相似。BNP和CRP具有高特异性，但敏感性有限，而MPO特异性较低。仅MCP具有低LR(-)，应进一步研究。联合多标志物组合的敏感性和特异性出人意料地低，LR(-)为0.84，这表明该组合不是减少不必要CPU检测的有效筛查试验。
