Suzuki Kenichiro, Komukai Kimiaki, Nakata Kotaro, Kang Ryeonshi, Oi Yuhei, Muto Eri, Kashiwagi Yusuke, Tominaga Mitsutoshi, Miyanaga Satoru, Ishikawa Tetsuya, Okuno Kenji, Uzura Masahiko, Yoshimura Michihiro
Division of Cardiology, The Jikei University Kashiwa Hospital, Japan.
Emergency and Critical Care Center, The Jikei University Kashiwa Hospital, Japan.
Intern Med. 2018 Jun 15;57(12):1673-1680. doi: 10.2169/internalmedicine.0098-17. Epub 2018 Feb 9.
Objective This study was carried out to examine the usefulness of point-of-care (POC) cardiac troponin in diagnosing acute coronary syndrome (ACS) and to understand the limitations of a POC cardiac troponin I/T-based diagnoses. Methods Patients whose cardiac troponin levels were measured in the emergency department using a POC system (AQT System; Radiometer, Tokyo, Japan) between January and December 2016 were retrospectively examined (N=1,449). Patients who were < 20 years of age or who were admitted with cardiopulmonary arrest were excluded. The sensitivity and specificity of the POC cardiac troponin levels for the diagnosis of ACS were determined. Result One hundred and twenty of 1,449 total patients had ACS (acute myocardial infarction, n=88; unstable angina n=32). On comparing the receiver operating characteristic (ROC) curves, the area under the curve (AUC) values for POC cardiac troponin I and cardiac troponin T were 0.833 and 0.786, respectively. The sensitivity and specificity of POC cardiac troponin I when using the 99th percentile (0.023 ng/mL) as the diagnostic cut-off value were 69.0% and 88.1%, respectively. The sensitivity of POC cardiac troponin I (99th percentile) was higher in the patients sampled > 3 hours after symptom onset (83.3%) than in those sampled ≤ 3 hours after symptom onset (58.8%, p < 0.01). Conclusion When sampled > 3 hours after the onset of symptoms, the POC cardiac troponin I level is considered to be suitable for use in diagnosing ACS. However, when sampled ≤ 3 hours after the onset of symptoms, careful interpretation of POC cardiac troponins is therefore required to rule out ACS.
目的 本研究旨在探讨即时检测（POC）心肌肌钙蛋白在诊断急性冠状动脉综合征（ACS）中的实用性，并了解基于POC心肌肌钙蛋白I/T诊断的局限性。方法 回顾性研究2016年1月至12月在急诊科使用POC系统（AQT系统；Radiometer，东京，日本）检测心肌肌钙蛋白水平的患者（N = 1449）。排除年龄<20岁或因心肺骤停入院的患者。确定POC心肌肌钙蛋白水平对ACS诊断的敏感性和特异性。结果 1449例患者中120例患有ACS（急性心肌梗死，n = 88；不稳定型心绞痛，n = 32）。比较接受者操作特征（ROC）曲线，POC心肌肌钙蛋白I和心肌肌钙蛋白T的曲线下面积（AUC）值分别为0.833和0.786。以第99百分位数（0.023 ng/mL）作为诊断临界值时，POC心肌肌钙蛋白I的敏感性和特异性分别为69.0%和88.1%。症状发作后>3小时采样的患者中，POC心肌肌钙蛋白I（第99百分位数）的敏感性（83.3%）高于症状发作后≤3小时采样的患者（58.8%，p<0.01）。结论 症状发作后>3小时采样时，POC心肌肌钙蛋白I水平被认为适用于ACS的诊断。然而，症状发作后≤3小时采样时，因此需要仔细解读POC心肌肌钙蛋白以排除ACS。
