Green G B, Li D J, Bessman E S, Cox J L, Kelen G D, Chan D W
Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Acad Emerg Med. 1998 Aug;5(8):758-67. doi: 10.1111/j.1553-2712.1998.tb02501.x.
To determine and compare the prognostic abilities of early, single-sample measurements of cardiac troponin I (cTn-I), cardiac troponin T (cTn-T), and creatine kinase-MB (CK-MB) among ED patients with possible myocardial ischemia.
Prospective collection of clinical and serologic data using an identity-unlinked technique from patients with possible myocardial ischemia at 2 urban EDs. Outcome data concerning the occurrence of adverse events (AEs) during the 14 days after enrollment were used to calculate and compare the relative risks (RRs) and predictive values (with 95% confidence intervals) of the 3 markers for predicting AEs.
Among the 401 study patients, 105 AEs occurred in 67 patients. cTn-I, cTn-T, and CK-MB were all significantly predictive of AEs, with RRs of 3.87 (2.39, 6.26), 3.03 (1.92, 4.79), and 6.45 (4.74, 8.77), respectively. For prediction of AEs, sensitivity for each of the 3 markers was low (cTn-I = 15.38, cTn-T = 24.62, CK-MB = 15.38), while specificity was high (cTn-I = 97.62, cTn-T = 93.15, CK-MB = 99.70). No significant difference in predictive ability was found between cTn-I and cTn-T. However, a positive CK-MB result was a stronger predictor of AEs than either cTn-I (p = 0.01) or cTn-T (p = 0.001).
No significant difference in predictive abilities was found between cTn-I and cTn-T. However, routine testing for both CK-MB and either of the troponins may optimize early identification of high-risk patients so they may be targeted for a higher level of care and consideration of more aggressive therapies.
确定并比较在可能发生心肌缺血的急诊患者中，早期单次测量心肌肌钙蛋白I（cTn-I）、心肌肌钙蛋白T（cTn-T）和肌酸激酶同工酶MB（CK-MB）的预后能力。
采用身份无关技术，前瞻性收集来自2家城市急诊科可能发生心肌缺血患者的临床和血清学数据。使用入组后14天内不良事件（AE）发生情况的结局数据，计算并比较这3种标志物预测AE的相对风险（RR）和预测值（95%置信区间）。
在401例研究患者中，67例患者发生了105次AE。cTn-I、cTn-T和CK-MB均能显著预测AE，RR分别为3.87（2.39，6.26）、3.03（1.92，4.79）和6.45（4.74，8.77）。对于AE的预测，这3种标志物的敏感性均较低（cTn-I = 15.38，cTn-T = 24.62，CK-MB = 15.38），而特异性较高（cTn-I = 97.62，cTn-T = 93.15，CK-MB = 99.70）。cTn-I和cTn-T在预测能力上无显著差异。然而，CK-MB结果呈阳性比cTn-I（p = 0.01）或cTn-T（p = 0.001）更能有力地预测AE。
cTn-I和cTn-T在预测能力上无显著差异。然而，对CK-MB和任一肌钙蛋白进行常规检测可能会优化高危患者的早期识别，从而针对他们进行更高水平的护理，并考虑更积极的治疗。
