Wang Guang-Mei, Li Yong, Wu Shuo, Zheng Wen, Ma Jing-Jing, Xu Feng, Zheng Jia-Qi, Zhang He, Wang Jia-Li, Chen Yu-Guo
Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan 250012, China.
Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine; Institute of Emergency and Critical Care Medicine of Shandong University; Chest Pain Center; Qilu Hospital of Shandong University, Jinan 250012 China.
World J Emerg Med. 2022;13(3):163-168. doi: 10.5847/wjem.j.1920-8642.2022.033.
The early diagnosis of acute myocardial infarction (AMI) remains challenging, especially for institutions without the high-sensitive cardiac troponin (hs-cTn) assay. Herein, we aim to assess the value of creatine kinase-myocardial band isoenzyme (CK-MB) combined with different cardiac troponin (cTn) assays in AMI diagnosis.
This multicenter, observational study included 3,706 patients with acute chest pain from September 1, 2015, to September 30, 2017. We classified the participants into three groups according to the cTn assays: the point-of-care cTn (POC-cTn) group, the contemporary cTn (c-cTn) group, and hs-cTn group. The diagnostic value was quantified using sensitivity and the area under the curve (AUC).
Compared to the single POC-cTn/c-cTn assays, combining CK-MB and POC-cTn/c-cTn increased the diagnostic sensitivity of AMI (56.1% vs. 63.9%, <0.001; 82.7% vs. 84.3%, =0.025). In contrast, combining CK-MB and hs-cTn did not change the sensitivity compared with hs-cTn alone (95.0% vs. 95.0%, >0.999). In the subgroup analysis, the sensitivity of combining CK-MB and c-cTn increased with time from symptom onset <6 h compared with c-cTn alone (72.8% vs. 75.0%, =0.046), while the sensitivity did not increase with time from symptom onset >6 h (97.5% vs. 98.3%, =0.317). The AUC of the combination of CK-MB and POC-cTn significantly increased compared to the single POC-cTn assay (0.776 vs. 0.750, =0.002). The AUC of the combined CK-MB and c-cTn/hs-cTn assays did not significantly decrease compared with that of the single c-cTn/hs-cTn assays within 6 h.
The combination of CK-MB and POC-cTn or c-cTn may be valuable for the early diagnosis of AMI, especially when hs-cTn is not available.
急性心肌梗死（AMI）的早期诊断仍然具有挑战性，尤其是对于没有高敏肌钙蛋白（hs-cTn）检测方法的机构。在此，我们旨在评估肌酸激酶心肌型同工酶（CK-MB）联合不同心肌肌钙蛋白（cTn）检测方法在AMI诊断中的价值。
这项多中心观察性研究纳入了2015年9月1日至2017年9月30日期间3706例急性胸痛患者。我们根据cTn检测方法将参与者分为三组：即时检测cTn（POC-cTn）组、当代cTn（c-cTn）组和hs-cTn组。使用灵敏度和曲线下面积（AUC）对诊断价值进行量化。
与单一的POC-cTn/c-cTn检测方法相比，联合CK-MB和POC-cTn/c-cTn可提高AMI的诊断灵敏度（56.1%对63.9%，<0.001；82.7%对84.3%，=0.025）。相比之下，联合CK-MB和hs-cTn与单独使用hs-cTn相比，灵敏度没有变化（95.0%对95.0%，>0.999）。在亚组分析中，与单独使用c-cTn相比，联合CK-MB和c-cTn在症状发作<6小时时的灵敏度随时间增加（72.8%对75.0%，=0.046），而在症状发作>6小时时灵敏度没有随时间增加（97.5%对98.3%，=0.317）。与单一POC-cTn检测相比，CK-MB和POC-cTn联合检测的AUC显著增加（0.776对0.750，=0.002）。在6小时内，CK-MB与c-cTn/hs-cTn联合检测的AUC与单一c-cTn/hs-cTn检测相比没有显著降低。
CK-MB与POC-cTn或c-cTn联合检测可能对AMI的早期诊断有价值，尤其是在没有hs-cTn检测方法时。
