McCord James, Aurora Lindsey, Lindahl Bertil, Giannitsis Evangelos, Calle-Muller Carlos, Nowak Richard, Body Richard, Christ Michael, deFilippi Christopher R, Christenson Robert H, Jacobsen Gordon, Alquezar Aitor, Panteghini Mauro, Melki Dina, Plebani Mario, Verschuren Franck, French John, Bendig Garnet, Weiser Silvia, Mueller Christian
From the Heart & Vascular Institute.
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.
Crit Pathw Cardiol. 2019 Mar;18(1):10-15. doi: 10.1097/HPC.0000000000000163.
The TRAPID-AMI (High Sensitivity Cardiac Troponin T assay for rapid Rule-out of Acute Myocardial Infarction) study evaluated a rapid "rule-out" acute myocardial infarction (AMI). We evaluated what symptoms were associated with AMI as part of a substudy of TRAPID-AMI. There were 1282 patients evaluated from 12 centers in Europe, the United States of America, and Australia from 2011 to 2013. Multiple symptom variables were prospectively obtained and evaluated for association with the final diagnosis of AMI. Multivariate logistic regression analysis was done, and odds ratios (OR) were calculated. There were 213/1282 (17%) AMIs. Four independent predictors for the diagnosis of AMI were identified: radiation to right arm or shoulder [OR = 3.0; confidence interval (CI): 1.8-5.0], chest pressure (OR = 2.5; CI: 1.3-4.6), worsened by physical activity (OR = 1.7; CI: 1.2-2.5), and radiation to left arm or shoulder (OR = 1.7; CI: 1.1-2.4). In the entire group, 131 (10%) had radiation to right arm or shoulder, 897 (70%) had chest pressure, 385 (30%) worsened with physical activity, and 448 (35%) had radiation to left arm or shoulder. Duration of symptoms was not predictive of AMI. There were no symptoms predictive of non-AMI. Relationship between AMI size and symptoms was also studied. For 213 AMI patients, cardiac troponins I values were divided into 4 quartiles. Symptoms including pulling chest pain, supramammillary right location, and right arm/shoulder radiation were significantly more likely to occur in patients with larger AMIs. In a large multicenter trial, only 4 symptoms were associated with the diagnosis of AMI, and no symptoms that were associated with a non-AMI diagnosis.
TRAPID-AMI（用于急性心肌梗死快速排除的高敏心肌肌钙蛋白T检测）研究评估了一种急性心肌梗死（AMI）的快速“排除”方法。作为TRAPID-AMI子研究的一部分，我们评估了哪些症状与AMI相关。2011年至2013年期间，对来自欧洲、美国和澳大利亚12个中心的1282例患者进行了评估。前瞻性地获取了多个症状变量，并评估其与AMI最终诊断的相关性。进行了多因素逻辑回归分析，并计算了比值比（OR）。共有213/1282例（17%）为AMI。确定了4个诊断AMI的独立预测因素：放射至右臂或肩部[OR = 3.0；置信区间（CI）：1.8 - 5.0]、胸痛（OR = 2.5；CI：1.3 - 4.6）、体力活动时加重（OR = 1.7；CI：1.2 - 2.5）以及放射至左臂或肩部（OR = 1.7；CI：1.1 - 2.4）。在整个组中，131例（10%）有放射至右臂或肩部，897例（70%）有胸痛，385例（30%）体力活动时加重，448例（35%）有放射至左臂或肩部。症状持续时间不能预测AMI。没有症状可预测非AMI。还研究了AMI大小与症状之间的关系。对于213例AMI患者，心肌肌钙蛋白I值分为4个四分位数。包括牵拉性胸痛、乳头上方右侧位置以及右臂/肩部放射等症状在较大AMI患者中更易出现。在一项大型多中心试验中，只有4种症状与AMI诊断相关，且没有与非AMI诊断相关的症状。
