Seino Y, Nejima J, Takayama M, Takano T, Ohbayashi K
First Department of Internal Medicine, Nihon Medical School, Tokyo.
J Cardiol. 1998 May;31(5):281-7.
The recently developed whole blood rapid assay for cardiac troponin T (TROP T) was evaluated by a cooperative study of general practitioners and office cardiologists in the Tokyo area (Tokyo TROP T Trial). Seventy patients with suspected acute myocardial infarction treated at 14 medical clinics were enrolled in this study. The diagnostic efficacy of troponin T was compared with that of electrocardiographic evaluations and clinical standards for diagnosis of acute myocardial infarction. Twelve of the 70 patients (17.1%) had final diagnoses of acute myocardial infarction or severe unstable angina necessitating emergency coronary intervention. Troponin T was judged as positive when simultaneously measured serum troponin T was more than 0.25 ng/ml. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 58.6%, 33.3%, and 100% for electrocardiographic evaluation, and 58.3%, 100%, 100%, and 92.1% for troponin T, respectively. Presence of bundle branch block (11/70 cases) or previous myocardial infarction (14/70 cases) caused false positive readings on electrocardiography, and resulted in the lower positive predictive value. In contrast, troponin T was false in patients admitted within 4 hours after the onset, or patients with smaller infarct. The Tokyo TROP T Trial by general practitioners and office cardiologists concluded that the combination of electrocardiographic evaluation and use of troponin T is a rapid and efficient diagnostic method for the evaluation of patients with suspected acute myocardial infarction.
近期开发的用于检测心肌肌钙蛋白T（TROP T）的全血快速检测法，在东京地区由全科医生和门诊心脏病专家进行了一项合作研究评估（东京TROP T试验）。14家诊所收治的70例疑似急性心肌梗死患者纳入了本研究。将肌钙蛋白T的诊断效能与急性心肌梗死诊断的心电图评估及临床标准进行了比较。70例患者中有12例（17.1%）最终诊断为急性心肌梗死或严重不稳定型心绞痛，需要进行紧急冠状动脉介入治疗。当同时检测的血清肌钙蛋白T超过0.25 ng/ml时，肌钙蛋白T被判定为阳性。心电图评估的敏感性、特异性、阳性预测值和阴性预测值分别为100%、58.6%、33.3%和100%，肌钙蛋白T的分别为58.3%、100%、100%和92.1%。束支传导阻滞（11/70例）或既往心肌梗死（14/70例）的存在导致心电图出现假阳性读数，从而使阳性预测值降低。相比之下，发病后4小时内入院的患者或梗死面积较小的患者，肌钙蛋白T检测结果出现假阴性。由全科医生和门诊心脏病专家进行的东京TROP T试验得出结论，心电图评估与肌钙蛋白T的联合应用是评估疑似急性心肌梗死患者的快速有效诊断方法。
