Brown Aaron M, Wu Alan H B, Clopton Paul, Robey Jennifer L, Hollander Judd E
Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Ann Emerg Med. 2007 Aug;50(2):153-8, 158.e1. doi: 10.1016/j.annemergmed.2007.02.015. Epub 2007 Apr 27.
The emergency department (ED) evaluation of potential acute coronary syndrome patients is limited by the initial sensitivity of cell injury biochemical markers. Increased ST2, a protein thought to participate in the response to cardiovascular injury, has been noted to be prognostic in patients with acute myocardial infarction. We hypothesize that ST2 would be increased at presentation in ED chest pain patients with myocardial ischemia, thus allowing for the early identification of acute myocardial infarction, acute coronary syndrome, and 30-day adverse cardiovascular events, with an area under the receiver operator characteristic curve (AUC) for each outcome of greater than 0.7.
Patients aged 25 years or older and presenting to the ED with chest pain prompting an ECG were prospectively enrolled. ST2 was measured at presentation. Main outcomes were acute myocardial infarction, acute coronary syndrome, and 30-day events (death, acute myocardial infarction, or revascularization). Median ST2 values were calculated for patients with and without each outcome. The AUCs were calculated for each outcome. In a post hoc analysis, patients with outlying increased ST2 values were examined to determine possible alternative causes for ST2 expression.
There were 348 patients enrolled. The outcomes were acute myocardial infarction 17 patients (4.9%), acute coronary syndrome 39 (11.2%), and 30-day events 23 (6.6%). The AUCs for acute myocardial infarction, acute coronary syndrome, and 30-day events were 0.636, 0.630, and 0.579, respectively. ST2 did not predict acute myocardial infarction, acute coronary syndrome, or 30-day events. It was increased in a small number of patients with pulmonary disease, notably, pulmonary emboli, systemic infection or inflammation, and alcohol abuse.
ST2 was not of value in the evaluation of ED patients with potential acute coronary syndrome.
急诊科（ED）对潜在急性冠状动脉综合征患者的评估受细胞损伤生化标志物初始敏感性的限制。ST2是一种被认为参与心血管损伤反应的蛋白质，其升高已被证实对急性心肌梗死患者具有预后价值。我们假设，心肌缺血的ED胸痛患者就诊时ST2会升高，从而能够早期识别急性心肌梗死、急性冠状动脉综合征以及30天不良心血管事件，每个结局的受试者操作特征曲线下面积（AUC）大于0.7。
前瞻性纳入年龄在25岁及以上、因胸痛到ED就诊并接受心电图检查的患者。就诊时测量ST2。主要结局为急性心肌梗死、急性冠状动脉综合征以及30天事件（死亡、急性心肌梗死或血运重建）。计算有或无各结局患者的ST2中位数。计算每个结局的AUC。在事后分析中，对ST2值异常升高的患者进行检查，以确定ST2表达可能的其他原因。
共纳入348例患者。结局为急性心肌梗死17例（4.9%）、急性冠状动脉综合征39例（11.2%）以及30天事件23例（6.6%）。急性心肌梗死、急性冠状动脉综合征以及30天事件的AUC分别为0.636、0.630和0.579。ST2不能预测急性心肌梗死、急性冠状动脉综合征或30天事件。少数患有肺部疾病的患者ST2升高，特别是肺栓塞、全身感染或炎症以及酒精滥用患者。
ST2对评估潜在急性冠状动脉综合征的ED患者没有价值。
Zotero 插件