Gama R, Swain D G, Nightingale P G, Buckley B M
Department of Clinical Chemistry, Wolfson Research Laboratories, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK.
Postgrad Med J. 1990 May;66(775):375-7. doi: 10.1136/pgmj.66.775.375.
The diagnosis of acute myocardial infarction (AMI) in the elderly is difficult and often depends on the results of investigations. In a 3-month prospective study, 270 patients admitted to an acute geriatric unit were studied to determine the most effective diagnostic strategy for the diagnosis of AMI, and to assess the value of screening acute geriatric admissions for AMI. Patients were assessed clinically and investigated with serial electrocardiograms and measurements of serum creatine kinase (CK), aspartate aminotransferase (AST), and lactate dehydrogenase activities on three consecutive days after admission. Measurement of serum activity of CK and AST had a diagnostic sensitivity of 100% and specificity of 86.8% for AMI. This was the optimum combination of cardiac enzymes in the diagnosis of AMI. Although electrocardiograms on the first two days of admission had a low diagnostic sensitivity (33.3%) their usefulness was their high positive predictive value (100%) when characteristic of an AMI. AMI was considered in the differential diagnosis of 79 patients (29%). All 25 patients (9%) who had an AMI were in this group, and therefore screening all geriatric admissions for AMI is not clinically justified.
老年人急性心肌梗死（AMI）的诊断较为困难，通常取决于检查结果。在一项为期3个月的前瞻性研究中，对入住急性老年病科的270例患者进行了研究，以确定诊断AMI最有效的诊断策略，并评估筛查急性老年病入院患者是否患有AMI的价值。对患者进行了临床评估，并在入院后的连续三天进行了系列心电图检查以及血清肌酸激酶（CK）、天冬氨酸转氨酶（AST）和乳酸脱氢酶活性的测定。血清CK和AST活性测定对AMI的诊断敏感性为100%，特异性为86.8%。这是诊断AMI时心脏酶的最佳组合。虽然入院前两天的心电图诊断敏感性较低（33.3%），但其有用之处在于当具有AMI特征时其阳性预测值较高（100%）。79例患者（29%）的鉴别诊断中考虑了AMI。所有25例患有AMI的患者（9%）都在该组中，因此对所有老年病入院患者进行AMI筛查在临床上并无依据。
