早期肌酸激酶同工酶（CK-MB）升高可预测稳定型胸痛患者的缺血事件。

Early CK-MB elevations predict ischemic events in stable chest pain patients.

作者信息

Hedges J R, Young G P, Henkel G F, Gibler W B, Green T R, Swanson J R

机构信息

Department of Emergency Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.

出版信息

Acad Emerg Med. 1994 Jan-Feb;1(1):9-16. doi: 10.1111/j.1553-2712.1994.tb02794.x.

DOI:10.1111/j.1553-2712.1994.tb02794.x

PMID:7621159

Abstract

OBJECTIVE

To demonstrate that creatine kinase-MB fraction (CK-MB) elevations within three hours of presentation in the emergency department (ED) are associated with subsequent ischemic events in clinically stable chest pain patients.

METHODS

Prospective cohort study at two university- affiliated teaching hospitals. Participants were consenting ED chest pain patients 25 years old or older without evidence of rhythm or hemodynamic instability (n = 449). Exclusions included ST-segment elevation > or = 0.1 mV in > or = 2 electrocardiogram leads, chest wall trauma, abnormal x-ray studies, and incomplete data collection. Measurements included presenting and three-hour CK-MB levels, presenting ECG, initial clinical impression of coronary care unit need, and clinical follow up. Monitored adverse events included myocardial ischemia necessitating coronary angioplasty or cardiac bypass surgery, recurrent in-hospital myocardial infarction, bradycardia requiring pacing, emergent cardioversion, cardiogenic shock, ventricular fibrillation, and death.

RESULTS

Overall, nine (2%) of 449 patients experienced an ischemic event within the first 48 hours. All nine patients required either coronary angioplasty or bypass surgery. Four (44%) of the nine patients with 48-hour ischemic events had elevated CK-MB levels. Of 23 patients who had complications within one week of ED presentation, seven (30%) had elevated ED CK-MB levels. An elevated CK-MB level was associated with an ischemic event both within 48 hours (risk ratio 9.5; 95% CI 2.7-33.7) and within one week (risk ration 5.2; 95% CI 2.3-11.7).

CONCLUSIONS

An elevated CK-MB level within three hours of ED presentation is associated with a subsequent ischemic event in the clinically stable chest pain patient without ST-segment elevation. However, the ED CK-MB identifies only a minority or otherwise low-risk patients who develop ischemic events; other markers for diagnosing myocardial ischemia in the ED are needed.

摘要

目的

证明在急诊科（ED）就诊三小时内肌酸激酶同工酶（CK-MB）升高与临床症状稳定的胸痛患者随后发生的缺血事件相关。

方法

在两家大学附属医院进行前瞻性队列研究。参与者为年龄在25岁及以上、无节律或血流动力学不稳定证据的ED胸痛患者（n = 449）。排除标准包括≥2个心电图导联ST段抬高≥0.1 mV、胸壁创伤、X线检查异常以及数据收集不完整。测量指标包括就诊时和三小时后的CK-MB水平、就诊时的心电图、冠心病监护病房需求的初始临床印象以及临床随访。监测的不良事件包括需要冠状动脉成形术或心脏搭桥手术的心肌缺血、院内复发性心肌梗死、需要起搏的心动过缓、紧急心脏复律、心源性休克、心室颤动和死亡。

结果

总体而言，449例患者中有9例（2%）在最初48小时内发生缺血事件。所有9例患者均需要进行冠状动脉成形术或搭桥手术。9例发生48小时缺血事件的患者中有4例（44%）CK-MB水平升高。在ED就诊一周内出现并发症的23例患者中，7例（30%）ED时CK-MB水平升高。CK-MB水平升高与48小时内（风险比9.5；95%可信区间2.7 - 33.7）和一周内（风险比5.2；95%可信区间2.3 - 11.7）的缺血事件均相关。