deFilippi C R, Parmar R J, Potter M A, Tocchi M
Division of Cardiology, The University of Texas Medical Branch, Galveston 77555-0553, USA.
Eur Heart J. 1998 Nov;19 Suppl N:N42-7.
This prospective study of acute chest pain patients clinically at low risk for a myocardial infarction was designed to: determine the diagnostic accuracy of a cardiac troponin T (cTnT) ultra sensitive Rapid Assay (RAII) compared with the quantitative cTnT assay; evaluate the association of a positive RAII with the presence and severity of coronary artery disease (CAD); and determine the ability of the RAII result to predict adverse events during long-term follow-up.
A total of 199 patients referred for chest pain, without ST segment elevation on presenting ECG, underwent RAII, quantitative cTnT, CK and CK-MB tests drawn simultaneously > or = 10 h after symptom onset. An abnormal value for cTnT was defined as >0.1 ng.mL(-1). The presence and extent of CAD was recorded in patients undergoing angiography. Adverse events, including cardiac death, non-fatal infarction, and readmission for unstable angina or heart failure, were assessed long-term. An abnormal RAII was found in 41 (20-6%) patients. The RAII sensitivity for detecting abnormal quantitative cTnT levels was 100%, specificity 96.3% (158/164) and overall concordance 97.5%. Although the presenting ECG was normal or non-specific in 95%, ST depression or T wave inversion occurred in 17% of RAII-positive versus 2%, RAII-negative patients (P=0.004). Of RAII-positive patients who underwent angiography (79%), 87% had CAD and 60% had multivessel disease. Kaplan Meier event-free survival curves showed early separation and continued to modestly diverge for patients with positive and negative RAII (69% versus 90% one-year event-free survival, P=0.002).
In a chest pain population anticipated to have a low prevalence of acute coronary syndromes and a good prognosis, the RAII is a quick and reliable test. It provides an important initial opportunity to identify patients with a high prevalence of CAD and increased incidence of future cardiac events.
本前瞻性研究针对临床上心肌梗死低风险的急性胸痛患者，旨在：确定心肌肌钙蛋白T（cTnT）超敏快速检测法（RAII）与定量cTnT检测法相比的诊断准确性；评估RAII阳性与冠状动脉疾病（CAD）的存在及严重程度之间的关联；并确定RAII结果预测长期随访期间不良事件的能力。
共有199例因胸痛就诊、心电图检查时无ST段抬高的患者，在症状发作后≥10小时同时进行了RAII、定量cTnT、肌酸激酶（CK）和肌酸激酶同工酶（CK-MB）检测。cTnT异常值定义为>0.1 ng/mL（-1）。对接受血管造影的患者记录CAD的存在情况和范围。长期评估不良事件，包括心源性死亡、非致命性梗死以及因不稳定型心绞痛或心力衰竭再次入院情况。41例（20.6%）患者RAII结果异常。RAII检测定量cTnT水平异常的敏感性为100%，特异性为96.3%（158/164），总体一致性为97.5%。尽管95%的患者初始心电图正常或不具有特异性，但RAII阳性患者中有17%出现ST段压低或T波倒置，而RAII阴性患者中这一比例为2%（P = 0.004）。在接受血管造影的RAII阳性患者中（79%），87%患有CAD，60%患有多支血管病变。Kaplan Meier无事件生存曲线显示，RAII阳性和阴性患者早期出现分离，并持续轻度分化（一年无事件生存率分别为69%和90%，P = 0.002）。
在预计急性冠状动脉综合征患病率低且预后良好的胸痛患者群体中，RAII是一种快速且可靠的检测方法。它为识别CAD患病率高且未来心脏事件发生率增加的患者提供了重要的初始机会。
