Peacock Frank, Morris Deborah L, Anwaruddin Saif, Christenson Robert H, Collinson Paul O, Goodacre Steve W, Januzzi James L, Jesse Robert L, Kaski Juan C, Kontos Michael C, Lefevre Guillaume, Mutrie Dave, Sinha Manas K, Uettwiller-Geiger Denise, Pollack Charles V
Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Am Heart J. 2006 Aug;152(2):253-62. doi: 10.1016/j.ahj.2005.12.024.
Because of possible adverse outcomes, many of the >6 million annual emergency department (ED) patients with suspected acute coronary syndromes (ACS) undergo extensive evaluations. To minimize medical errors, chest pain evaluations are structured to identify accurately nearly 100% of patients with ACS. This is at a cost of negative evaluation rates that can exceed 90%. Ischemia-modified albumin (IMA), a serum biomarker with a high negative predictive value (NPV) at ED presentation, may exclude ACS. Our objective was to perform a meta-analysis of IMA use for ACS risk stratification.
By computer literature search and communication with authors of unpublished information, all IMA data were considered. This analysis included studies if they reported IMA results from an ED presentation for suspected ACS. We defined a negative triple prediction test (TPT) as a nondiagnostic electrocardiogram, negative troponin, and negative IMA.
Eight studies of >1800 patients met the entry criteria. The TPT sensitivity and NPV for acute ACS were 94.4% and 97.1% and, for longer-term outcomes, were 89.2% and 94.5%, respectively.
A negative TPT of a nondiagnostic electrocardiogram, negative troponin, and negative IMA has a high NPV for excluding ACS in the ED.
由于可能出现不良后果，每年超过600万疑似急性冠状动脉综合征（ACS）的急诊科患者会接受广泛评估。为尽量减少医疗差错，胸痛评估流程旨在准确识别近100%的ACS患者。但这样做的代价是阴性评估率可能超过90%。缺血修饰白蛋白（IMA）是一种在急诊科就诊时具有高阴性预测值（NPV）的血清生物标志物，可能有助于排除ACS。我们的目的是对IMA用于ACS风险分层进行荟萃分析。
通过计算机文献检索及与未发表信息的作者沟通，纳入所有IMA数据。若研究报告了疑似ACS患者急诊科就诊时的IMA结果，则纳入本分析。我们将阴性三联预测试验（TPT）定义为心电图无诊断意义、肌钙蛋白阴性且IMA阴性。
八项涉及1800多名患者的研究符合纳入标准。急性ACS的TPT敏感性和NPV分别为94.4%和97.1%，对于长期预后，分别为89.2%和94.5%。
心电图无诊断意义、肌钙蛋白阴性且IMA阴性的阴性TPT在急诊科排除ACS方面具有较高的NPV。
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