Mair J, Smidt J, Lechleitner P, Dienstl F, Puschendorf B
Department of Medical Chemistry, University of Innsbruck (Austria) School of Medicine.
Chest. 1995 Dec;108(6):1502-9. doi: 10.1378/chest.108.6.1502.
To find an accurate algorithm for the diagnosis of acute myocardial infarction in nontraumatic chest pain patients on presentation to the emergency department.
In a prospective clinical study, we compared the diagnostic performances of clinical symptoms, presenting ECG, creatinine kinase, creatine kinase MB activity and mass concentration, myoglobin, and cardiac troponin T test results of hospital admission blood samples. By classification and regression trees, a decision tree for the diagnosis of acute myocardial infarction was developed.
Emergency room of a Department of Internal Medicine (University Hospital).
One hundred fourteen nontraumatic chest pain patients (median delay from onset of chest pain to hospital admission, 3 h; range, 0.33 to 22): 26 Q-wave and 19 non-Q-wave myocardial infarctions, 49 patients with unstable angina pectoris, and 20 patients with chest pain caused by other diseases.
Of each parameter taken by itself, the ECG was tendentiously most informative (areas under receiver operating characteristic plots: 0.87 +/- 0.04 [ECG], 0.80 +/- 0.08 [myoglobin], 0.80 +/- 0.04 [creatine kinase MB mass], 0.77 +/- 0.04 [creatine kinase activity], 0.69 +/- 0.06 [clinical symptoms] 0.67 +/- 0.06 [creatine kinase MB activity], 0.67 +/- 0.05 [troponin T]). In patients presenting 3 h or less after the onset of chest pain, ECG signs of acute transmural myocardial ischemia were the best discriminator between patients with and without myocardial infarction. In patients presenting more than 3 h, however, creatine kinase MB mass concentrations (discriminator value, 6.7 micrograms/L) were superior to the ECG, clinical symptoms, and all other biochemical markers tested. This algorithm for diagnosing acute myocardial infarction was superior to each parameter by itself and was characterized by 0.91 sensitivity, a 0.90 specificity, a 0.90 positive and negative predictive value, and a 0.90 efficiency.
We found an algorithm that could accurately separate the myocardial infarction patients from the others on admission to the emergency department. Therefore, this classifier could be a valuable diagnostic aid for rapid confirmation of a suspected myocardial infarction.
找到一种准确的算法，用于诊断非创伤性胸痛患者就诊于急诊科时是否患有急性心肌梗死。
在一项前瞻性临床研究中，我们比较了临床症状、就诊时心电图、肌酐激酶、肌酸激酶MB活性和质量浓度、肌红蛋白以及入院血样中心肌肌钙蛋白T检测结果的诊断性能。通过分类回归树，开发了一种用于诊断急性心肌梗死的决策树。
内科（大学医院）急诊科。
114例非创伤性胸痛患者（胸痛发作至入院的中位延迟时间为3小时；范围为0.33至22小时）：26例Q波心肌梗死和19例非Q波心肌梗死患者、49例不稳定型心绞痛患者以及20例由其他疾病引起胸痛的患者。
就每个单独的参数而言，心电图在诊断方面最具倾向性（受试者工作特征曲线下面积：0.87±0.04[心电图]、0.80±0.08[肌红蛋白]、0.80±0.04[肌酸激酶MB质量]、0.77±0.04[肌酸激酶活性]、0.69±0.06[临床症状]、0.67±0.06[肌酸激酶MB活性]、0.67±0.05[肌钙蛋白T]）。在胸痛发作后3小时或更短时间就诊的患者中，急性透壁心肌缺血的心电图表现是区分有无心肌梗死患者的最佳指标。然而，在胸痛发作后超过3小时就诊的患者中，肌酸激酶MB质量浓度（区分值为6.7微克/升）优于心电图、临床症状以及所有其他检测的生化标志物。这种诊断急性心肌梗死的算法优于每个单独的参数，其特点是灵敏度为0.91、特异度为0.90、阳性和阴性预测值均为0.90、效率为0.90。
我们发现了一种算法，能够在患者就诊于急诊科时准确地将心肌梗死患者与其他患者区分开来。因此，该分类器对于快速确诊疑似心肌梗死可能是一种有价值的诊断辅助工具。
