Department of Emergency Medicine, Henry Ford Health System, Detroit, MI, USA.
Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.
Am J Emerg Med. 2018 Oct;36(10):1849-1854. doi: 10.1016/j.ajem.2018.06.073. Epub 2018 Jul 2.
Differentiation of type 1 (T1MI) from type 2 myocardial infarction (T2MI) is important as recommended treatments for each differ. Patients with T2MI may have more/earlier cardiac wall stress resulting in an increased N-terminal pro B-type natriuretic peptide (NT-proBNP)/cTnT generation 5 ratio (cTnT Gen 5).
Emergency Department (ED) patients presenting with symptoms suspicious for acute coronary syndrome (ACS) were enrolled from 2013 to 2015. Baseline blood samples were collected within 60 min of a triage ECG, with additional draws at 30, 60 and 180 min. NT-proBNP and cTnT Gen 5 levels were measured later in an independent laboratory. Acute myocardial infarction (AMI) was adjudicated using the Third Universal Definition of Myocardial Infarction.
575 patients were enrolled with 44 (7.7%) having AMI [25 T1MI (59.1%) and 18 T2MI (40.9%)]. Patient characteristics showed very few AMI type differences so accurate clinical differentiation was difficult. The median NT-proBNP/cTnT Gen 5 ratios were significantly higher in T2MI when compared to T2MI at baseline and 30, 60 and 180 min later [7.3 v 53.0 (p = 0.003), 5.8 v 49.5 (p = 0.002), 6.3 v 47.5 (p = 0.003) and 4.3 v 33.7 (p = 0.016) respectively].
The clinical determination of whether an AMI is type 1 or 2 is difficult as the ED patient characteristics of each are similar. The NT-proBNP/cTnT Gen 5 ratio can aid in making this differentiation. Additional multicenter trials are needed to validate our results.
区分 1 型（T1MI）和 2 型心肌梗死（T2MI）非常重要，因为每种类型的推荐治疗方法不同。2 型心肌梗死患者可能会更早/更多地产生心脏壁压力，从而导致 N 末端脑利钠肽前体（NT-proBNP）/cTnT 生成 5 比率（cTnT Gen 5）升高。
2013 年至 2015 年期间，从出现急性冠状动脉综合征（ACS）症状的急诊科（ED）患者中招募了该研究对象。在分诊心电图后 60 分钟内采集基线血液样本，并在 30、60 和 180 分钟时进行额外采集。NT-proBNP 和 cTnT Gen 5 水平随后在独立实验室进行测量。采用第三次心肌梗死通用定义对急性心肌梗死（AMI）进行判定。
共纳入 575 例患者，其中 44 例（7.7%）发生 AMI[25 例 1 型心肌梗死（59.1%）和 18 例 2 型心肌梗死（40.9%）]。患者特征显示 AMI 类型差异很小，因此准确的临床鉴别诊断较为困难。与基线相比，2 型心肌梗死患者的 NT-proBNP/cTnT Gen 5 比值在 30、60 和 180 分钟时均显著更高[7.3 比 53.0（p=0.003），5.8 比 49.5（p=0.002），6.3 比 47.5（p=0.003）和 4.3 比 33.7（p=0.016）]。
由于 ED 患者的特征相似，因此很难确定 AMI 是 1 型还是 2 型。NT-proBNP/cTnT Gen 5 比值有助于做出这种区分。需要进一步开展多中心试验来验证我们的结果。
