Department of Pathology and Molecular Medicine, McMaster University, and Hamilton Regional Laboratory Medicine Program, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada.
Clin Chem. 2012 Jan;58(1):298-302. doi: 10.1373/clinchem.2011.172064. Epub 2011 Sep 20.
Most outcome studies of patients presenting early to the emergency department with potential acute coronary syndromes have focused on either the index diagnosis of myocardial infarction (MI) or a composite end point at a later time frame (30 days or 1 year). We investigated the performance of 9 biomarkers for an early serious outcome.
Patients (n=186) who presented to the emergency department within 6 h of chest pain onset had their presentation serum sample measured for the following analytes: creatine kinase, creatine kinase isoenzyme MB, enhanced AccuTnI troponin I (Beckman Coulter), high-sensitivity cardiac troponin T (hs-cTnT), ischemia-modified albumin, interleukin-6, investigation use only hs-cTnI (Beckman Coulter), N-terminal pro-B-type natriuretic peptide, and cardiac troponin I (Abbott AxSym). We followed patients until 72 h after presentation and determined whether they experienced the following serious cardiac outcomes: MI, heart failure, serious arrhythmia, refractory ischemic cardiac pain, or death. ROC curves were analyzed to determine the area under the ROC curve (AUC) and optimal cutoffs for the biomarkers.
The AUCs for the hs-cTnI assay (0.86; 95% CI, 0.76-0.96), the AccuTnI assay (0.86; 95% CI, 0.78-0.95), and the hs-cTnT assay (0.82; 95% CI, 0.71-0.94) assays were significantly higher than those for the other 6 assays (AUC values≤0.71 for the rest of the biomarkers, P<0.05). The ROC curve-derived optimal cutoffs were ≥19 ng/L (diagnostic sensitivity, 80%; specificity, 88%), ≥0.018 μg/L (diagnostic sensitivity, 75%; specificity, 86%), and ≥32 ng/L (diagnostic sensitivity, 68%; specificity, 92%) for the hs-cTnI, AccuTnI, and hs-cTnT assays, respectively.
The optimal cutoffs for predicting serious cardiac outcomes in this low-risk population are different from the published 99th percentiles. Larger studies are required to verify these findings.
大多数对急诊早期出现疑似急性冠状动脉综合征的患者进行的预后研究，要么聚焦于心肌梗死（MI）的指数诊断，要么聚焦于稍后时间点（30 天或 1 年）的复合终点。我们研究了 9 种生物标志物对早期严重预后的预测价值。
胸痛发作后 6 小时内就诊于急诊科的患者，在就诊时检测其血清样本中的以下分析物：肌酸激酶、肌酸激酶同工酶 MB、增强型 AccuTnI 肌钙蛋白 I（贝克曼库尔特）、高敏心肌肌钙蛋白 T（hs-cTnT）、缺血修饰白蛋白、白细胞介素-6、仅限调查用高敏肌钙蛋白 I（贝克曼库尔特）、N 末端 pro-B 型利钠肽和心脏肌钙蛋白 I（雅培 AxSym）。我们随访患者至就诊后 72 小时，确定他们是否发生以下严重心脏结局：心肌梗死、心力衰竭、严重心律失常、难治性缺血性心前区疼痛或死亡。分析 ROC 曲线以确定生物标志物的 ROC 曲线下面积（AUC）和最佳截断值。
hs-cTnI 检测（AUC：0.86；95%CI：0.76-0.96）、AccuTnI 检测（AUC：0.86；95%CI：0.78-0.95）和 hs-cTnT 检测（AUC：0.82；95%CI：0.71-0.94）的 AUC 显著高于其他 6 种检测方法（其余生物标志物的 AUC 值均≤0.71，P<0.05）。根据 ROC 曲线得出的最佳截断值分别为≥19ng/L（诊断灵敏度 80%，特异性 88%）、≥0.018μg/L（诊断灵敏度 75%，特异性 86%）和≥32ng/L（诊断灵敏度 68%，特异性 92%），用于 hs-cTnI、AccuTnI 和 hs-cTnT 检测。
在这个低危人群中，预测严重心脏结局的最佳截断值与已发表的第 99 百分位数不同。需要更大的研究来验证这些发现。
