Puleo P R, Meyer D, Wathen C, Tawa C B, Wheeler S, Hamburg R J, Ali N, Obermueller S D, Triana J F, Zimmerman J L
Department of Medicine, Christ Hospital, Cincinnati.
N Engl J Med. 1994 Sep 1;331(9):561-6. doi: 10.1056/NEJM199409013310901.
Ruling out myocardial infarction in patients coming to the emergency room with chest pain is hindered by the lack of a specific early diagnostic marker. Less than 30 percent of patients admitted to coronary care units have infarction, resulting in substantial unnecessary expenditures. We developed a rapid assay of the subforms of creatine kinase MB (CK-MB) and prospectively analyzed its sensitivity and specificity in diagnosing myocardial infarction in the first six hours after the onset of chest pain.
In 1110 consecutive patients who came to the emergency room with chest pain, blood samples were collected every 30 to 60 minutes until at least 6 hours after the onset of symptoms; in patients who were then admitted to the hospital, samples were collected every 4 hours for up to 48 hours. The samples were analyzed for CK-MB subforms, and the diagnosis of myocardial infarction was confirmed by conventional CK-MB analysis.
Of the 1110 patients evaluated, 121 had myocardial infarction. The sensitivity of the assay of CK-MB subforms to detect myocardial infarction in the first six hours after the onset of symptoms was 95.7 per cent, as compared with only 48 percent for the conventional CK-MB assay; the specificity was 93.9 percent among patients hospitalized without myocardial infarction and 96.2 percent among those sent home. Among the patients with myocardial infarction, definitive results of the subform assay were available a mean (+/- SD) of 1.22 +/- 1.17 hours after their arrival in the emergency room.
The assay of CK-MB subforms reliably detected myocardial infarction within the first six hours after the onset of symptoms, and its use could reduce admission to the coronary care unit by 50 to 70 percent, thereby reducing costs.
因缺乏特异性早期诊断标志物，在因胸痛前来急诊室的患者中排除心肌梗死存在困难。入住冠心病监护病房的患者中，不到30%患有心肌梗死，导致大量不必要的费用支出。我们开发了一种肌酸激酶MB（CK-MB）亚型的快速检测方法，并前瞻性分析了其在胸痛发作后最初6小时内诊断心肌梗死的敏感性和特异性。
在1110例因胸痛前来急诊室的连续患者中，每30至60分钟采集一次血样，直至症状发作后至少6小时；对于随后入院的患者，每4小时采集一次血样，持续48小时。对血样进行CK-MB亚型分析，心肌梗死的诊断通过传统CK-MB分析来确认。
在评估的1110例患者中，121例患有心肌梗死。症状发作后最初6小时内，CK-MB亚型检测法检测心肌梗死的敏感性为95.7%，而传统CK-MB检测法仅为48%；在未发生心肌梗死的住院患者中，特异性为93.9%，在出院患者中为96.2%。在心肌梗死患者中，亚型检测的明确结果在他们抵达急诊室后平均（±标准差）1.22±1.17小时即可获得。
CK-MB亚型检测法能在症状发作后的最初6小时内可靠地检测出心肌梗死，使用该方法可使冠心病监护病房的入院率降低50%至70%，从而降低成本。
