Chenevier-Gobeaux Camille, Meune Christophe, Lefevre Guillaume, Doumenc Benoit, Sorbets Emmanuel, Peschanski Nicolas, Ray Patrick
Department of Automated Biological Diagnosis, Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), 75014 Paris Cedex, France.
Department of Cardiology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine Saint Denis, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, Université Paris 13, UMR S-942, Paris, France.
Clin Biochem. 2016 Oct;49(15):1113-1117. doi: 10.1016/j.clinbiochem.2016.05.021. Epub 2016 May 24.
Recent 2015 ESC recommendations for the management of patients with suspected acute myocardial infarction (AMI) support that a single value of high-sensitivity cardiac troponin (HS-cTn) measured at presentation could rule out AMI if below the limit of blank (LoB) or detection (LoD).
We aimed to evaluate whether an undetectable HS-cTnT at presentation safely rules out NSTEMI in unselected patients with chest pain.
This is a post hoc analysis of two prospective cohorts with similar design that included patients suspected of AMI at three French university hospitals. Patients were followed-up during one month, before the adjudication of a final diagnosis.
413 patients (mean age 58±17years) were analyzed; 45 (11%) had a final diagnosis of NSTEMI, and 26 (6%) had STEMI. The sensitivity of HS-cTnT value at 3ng/L (LoB) for NSTEMI was 97.8% [95% CI: 86.8-99.9], yielding a negative predictive value (NPV) of 99.3% [95% CI: 95.4-100.0]. Proportion of patients ruled out for NSTEMI was 32% when applying the LoB. The sensitivity of HS-cTnT value at 5ng/L (LoD) was 97.8% [95% CI: 86.8-99.9] yielding a NPV of 99.5% [95% CI: 96.5-100.0]. Proportion of patients ruled out for NSTEMI was 43% when applying the LoD. One patient (delay between onset of chest pain and presentation <3h) had NSTEMI and HS-cTnT <LoB at presentation.
The NPV of a single measurement of HS-cTnT below the LoD is high in unselected patients, but not enough to rule out safely NSTEMI for very early presenters.
2015年欧洲心脏病学会（ESC）近期发布的疑似急性心肌梗死（AMI）患者管理指南支持，就诊时单次检测的高敏心肌肌钙蛋白（HS-cTn）值若低于检测下限（LoB）或检测限（LoD），则可排除AMI。
我们旨在评估就诊时无法检测到HS-cTnT是否能安全排除未选择的胸痛患者中的非ST段抬高型心肌梗死（NSTEMI）。
这是对两个设计相似的前瞻性队列进行的事后分析，队列纳入了法国三家大学医院疑似AMI的患者。在最终诊断判定前，对患者进行了为期1个月的随访。
分析了413例患者（平均年龄58±17岁）；45例（11%）最终诊断为NSTEMI，26例（6%）为ST段抬高型心肌梗死（STEMI）。HS-cTnT值在3ng/L（LoB）时对NSTEMI的敏感性为97.8% [95%可信区间（CI）：86.8 - 99.9]，阴性预测值（NPV）为99.3% [95% CI：95.4 - 100.0]。应用LoB时，被排除NSTEMI的患者比例为32%。HS-cTnT值在5ng/L（LoD）时的敏感性为97.8% [95% CI：86.8 - 99.9]，NPV为99.5% [95% CI：96.5 - 100.0]。应用LoD时，被排除NSTEMI的患者比例为43%。1例患者（胸痛发作与就诊之间的延迟<3小时）患有NSTEMI，就诊时HS-cTnT<LoB。
在未选择的患者中，单次测量HS-cTnT低于LoD的NPV较高，但对于就诊非常早的患者，不足以安全排除NSTEMI。
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