Dupuy Anne Marie, Cristol Jean Paul, Kuster Nils, Reynier Robin, Lefebvre Sophie, Badiou Stéphanie, Jreige Riad, Sebbane Mustapha
Biochemistry Laboratory, Lapeyronie Hospital, Montpellier, France.
Biochemistry Laboratory, Lapeyronie Hospital, Montpellier, France.
Am J Emerg Med. 2015 Mar;33(3):326-30. doi: 10.1016/j.ajem.2014.11.012. Epub 2014 Nov 15.
We sought to evaluate the added value of heart fatty acid protein assay (HFABP) for rapid diagnosis of acute myocardial infarction in a prospective cohort of emergency department (ED) patients with acute chest pain.
High-sensitivity cardiac troponin T (hs-cTnT; Roche Diagnostics, Meylan, France) and HFABP (Randox, Mauguio, France) were blindly assayed from venous blood samples obtained at admission. Diagnosis was made by 2 ED physicians using all available data and serial cardiac troponin I as the biochemical standard. Diagnostic performances of HFABP combined with hs-cTnT were assessed using logistic regression. Analysis was conducted in all patients and in patients without ST-elevation myocardial infarction.
A total of 181 patients were included (age, 61 ±17 years; male sex, 66%). Acute myocardial infarction occurred in 47 (25.9%) patients, including non-ST-elevation myocardial infarction in 31 (17.1%). The receiver operating characteristic area under the curve was 0.893 for hs-cTnT levels at presentation (95% confidence interval, 0.812-0.974) and 0.908 (95% confidence interval, 0.839-0.977) for the combination of hs-cTnT and HFABP, with no significant (P=.07). Adding HFABP to hs-cTnT increased both sensitivity and negative predictive value (NPV) for non-ST-elevation myocardial infarction diagnosis, with about 13% and 3% increase, respectively, leading to a sensitivity of 97% and an NPV of 99%.
The assessment of HFABP at ED admission adds incremental value to initial hs-cTnT. The increase of sensitivity and NPV without sacrificing the specificity and positive predictive value in patients with chest pain with noncontributive electrocardiogram could potentially allow safe and early rule out of acute myocardial infarction without the need for further serial troponin testing.
我们试图在前瞻性队列研究的急诊科急性胸痛患者中评估心脏脂肪酸结合蛋白检测（HFABP）对急性心肌梗死快速诊断的附加价值。
从入院时采集的静脉血样本中盲法检测高敏心肌肌钙蛋白T（hs-cTnT；罗氏诊断公司，法国梅兰）和HFABP（兰道克斯公司，法国莫吉奥）。由两名急诊科医生利用所有可用数据并以连续心肌肌钙蛋白I作为生化标准进行诊断。采用逻辑回归评估HFABP联合hs-cTnT的诊断性能。在所有患者以及无ST段抬高型心肌梗死的患者中进行分析。
共纳入181例患者（年龄61±17岁；男性占66%）。47例（25.9%）患者发生急性心肌梗死，其中31例（17.1%）为非ST段抬高型心肌梗死。就诊时hs-cTnT水平的曲线下面积为0.893（95%置信区间，0.812 - 0.974），hs-cTnT与HFABP联合检测的曲线下面积为0.908（95%置信区间，0.839 - 0.977），差异无统计学意义（P = 0.07）。将HFABP加入hs-cTnT可提高非ST段抬高型心肌梗死诊断的敏感性和阴性预测值（NPV），分别提高约13%和3%，敏感性达到97%，NPV达到99%。
急诊科入院时评估HFABP可为初始hs-cTnT增添附加价值。对于心电图无诊断意义的胸痛患者，在不牺牲特异性和阳性预测值的情况下提高敏感性和NPV，可能使安全、早期排除急性心肌梗死成为可能而无需进一步连续检测肌钙蛋白。
