单一肌钙蛋白测量排除早期就诊急性心肌梗死。

Single troponin measurement to rule-out acute myocardial infarction in early presenters.

机构信息

Research Center for Emergency Medicine, Aarhus University, Palle Juul-Jensens Boulevard 161, Building J103, 8200 Aarhus N, Aarhus, Denmark; Clinical Research Unit, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark; Department of Internal Medicine, Randers Regional Hospital, Skovlyvej 15, 8930 Randers, Denmark.

Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Aarhus, Denmark.

出版信息

Int J Cardiol. 2021 Oct 15;341:15-21. doi: 10.1016/j.ijcard.2021.08.005. Epub 2021 Aug 13.

DOI:10.1016/j.ijcard.2021.08.005

PMID:34391791

Abstract

BACKGROUND

A single high-sensitive cardiac troponin (hs-cTn) can be used to rule-out acute myocardial infarction (MI) in patients presenting >3 hours (3 h) after chest pain onset to the emergency department. This study aimed to investigate the safety of ruling-out MI in early presenters with chest pain ≤3 h using a single hs-cTnI at admission.

METHODS

We prospectively enrolled patients presenting with chest pain suggestive of MI. Hs-cTnI (Siemens ADVIA Centaur TNIH, Limit of detection: 2.2 ng/L) was measured at admission. Two physicians adjudicated final diagnosis. A diagnostic cut-off value <3 ng/L was used to rule-out MI. Patients were classified as early (chest pain ≤3 h) or late presenters (>3 h).

RESULTS

We included 1370 patients with available admission hs-cTnI results: median (Q1-Q3) age 65 (52-74), female sex: 43%, previous MI: 22%. We confirmed MI in 118 (8.6%) patients. Overall, 470 (34%) patients were classified as early, 770 (56%) as late presenters, and 130 (9%) patients had unknown onset. When applying the diagnostic cut-off value, MI was correctly ruled-out at admission in 370 (27%) patients: 134 (29%) early presenters, 206 (27%) late presenters and 30 (23%) patients with unknown onset. This resulted in an overall negative predictive value of 100% (95% CI: 99.0-100%), with both 100% (97.3-100%) for early and 100% (98.2-100%) for late presenters, respectively. Sensitivity was similarly high in the two groups.

CONCLUSION

MI could be safely ruled-out in all patients presenting with chest pain ≤3 h when using a single hs-cTnI value <3 ng/L as diagnostic cut-off.

TRIAL REGISTRATION NUMBER

NCT03634384.

摘要

背景

在胸痛发作后 3 小时（3 h）以上就诊急诊科的患者中，单次高敏肌钙蛋白（hs-cTn）可用于排除急性心肌梗死（MI）。本研究旨在探讨在胸痛发作≤3 h 的早期患者中，采用单次 hs-cTnI 入院时排除 MI 的安全性。

方法

我们前瞻性纳入胸痛提示 MI 的患者。入院时测定 hs-cTnI（Siemens ADVIA Centaur TNIH，检测下限：2.2ng/L）。两名医师判定最终诊断。采用<3ng/L 的诊断截断值排除 MI。患者分为早期（胸痛≤3 h）和晚期（>3 h）。

结果

我们纳入了 1370 例可获得入院 hs-cTnI 结果的患者：中位（Q1-Q3）年龄 65（52-74）岁，女性占 43%，既往有 MI 占 22%。我们共确诊 118 例（8.6%）MI 患者。总体而言，470 例（34%）患者为早期，770 例（56%）为晚期，130 例（9%）患者胸痛发作时间未知。应用诊断截断值时，134 例（29%）早期、206 例（27%）晚期和 30 例（23%）胸痛发作时间未知的患者入院时 MI 得到正确排除，总的阴性预测值为 100%（95%CI：99.0-100%），早期和晚期患者的阴性预测值分别为 100%（97.3-100%）和 100%（98.2-100%）。两组的敏感性均较高。