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1.
目的探讨肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、肌红蛋白(MYO)3种心肌标志物检测对急性心肌梗死(AMI)早期诊断的价值。方法用胶体金免疫层析法测定120例心肌梗死患者的3种血清心肌标志物的浓度,比较其对AMI诊断的性能价值。结果 120例心肌梗死患者在胸痛发作6h内检测cTnT、CK-MB和MYO的敏感率分别是81.4%、60.5%和97.7%,以MYO浓度升高最快,出现最早;发病6h~24h内检测cTnT、CK-MB和MYO的敏感率分别是99.0%、79.4%和79.0%,以cTnT浓度最稳定;在发病8h内检测cTnT、CK-MB和MYO的敏感性分别为91.0%、70.0%和99.0%,特异性分别为100%、91.0%和79.0%;漏诊率分别是9.0%、30.0%和1.0%;误诊率分别是0、9.0%和21.0%。结论 cTnT在AMI早期诊断中具有较高的敏感性、特异性和准确性,是早期诊断AMI的"金指标",MYO可作为AMI的过筛,三者结合可提高早期AMI的诊断率,并有助于病情的分析。  相似文献   

2.
We evaluated cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) for risk stratification of chest pain unit (CPU) patients. We studied 383 consecutive patients with chest pain assigned to our CPU by emergency department physicians. At baseline all had normal or nondiagnostic electrocardiograms, no high-risk clinical features, and negative CK/CK-MB. CK-MB and electrocardiograms were taken at 0, 4, 8, and 12 hours and cTnT at 0, 4, and 8 hours. Eight patients (2.1%) were CK-MB positive and 39 (10.2%) were cTnT positive, including all but 1 CK-MB-positive patient. All marker-positive patients were detected by 8 hours. Seven cTnT-positive patients and 1 cTnT-negative patient had myocardial infarction (p <0.0001). cTnT-positive patients were older, less likely to be women or smokers, and more often had diabetes mellitus or known coronary disease (CAD). Seventy-one percent of patients underwent diagnostic testing. cTnT-positive patients more often underwent angiography (46% vs 20%) and underwent stress testing less often (28% vs 57%) than cTnT-negative patients. When performed, their stress tests were more often positive (46% vs 14%) and they more often had angiographically significant lesions (89% vs 49%) and multivessel disease (67% vs 29%). There were no short-term deaths. Long-term mortality was higher in cTnT-positive patients (27% vs 7%, p <0.0001). Thus, cTnT identified more CPU patients with myocardial necrosis and multivessel CAD than CK-MB and a population with high long-term mortality risk. Routine use of cTnT in CPUs could facilitate risk stratification and management.  相似文献   

3.
目的评价床边快速心肌肌钙蛋白T(cTnT)检测对以急性胸痛症状住院或转科的患者诊断的价值。方法采用床边快速心肌肌钙蛋白T测定仪(CARDIACREADER)测定502例以急性胸痛症状入院或转入心内科的患者入院即刻、6h、12h的cTnT水平,同时测定患者的心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶(CK)及其同功酶(CK-MB)水平。以心电图出现急性心肌梗死(AMI)的动态改变和(或)CK-MB和TnI同时升高诊断为心肌梗死,计算床边快速cTnT诊断急性心肌梗死的特异性、敏感性、阴性预测价值和阳性预测价值。结果502例急性胸痛患者,cTnT阳性160例(31.9%),cTnT阴性323例(64.3%),19例弱阳性。139例cTnT阳性患者发生AMI,7例cTnT阴性的患者发生AMI。床边快速cTnT对以急性胸痛症状住院或转科的患者诊断AMI的特异性为93.8%、敏感性为95.2%、阳性预测价值为86.9%、阴性预测价值为97.8%。结论床边快速肌钙蛋白T测定可以迅速准确地在急性胸痛患者中识别或排除AMI患者,具有重要的诊断价值。  相似文献   

4.
STUDY OBJECTIVES: This study tested the hypothesis that serial creatine phosphokinase (CK)-MB sampling in the emergency department can identify acute myocardial infarction (AMI) in patients presenting to the ED with chest pain and nondiagnostic ECGs. DESIGN: Patients more than 30 years old who were evaluated initially in the ED and hospitalized for chest pain were studied. Serial CK-MB levels were analyzed prospectively using a rapid serum immunochemical assay for identification of AMI patients in the ED. Presenting ECGs showing new, greater than 1-mm ST elevation in two or more contiguous leads were considered diagnostic for AMI. All other ECGs were considered nondiagnostic ECGs. CK-MB levels were determined at ED presentation and hourly for three hours (total of four levels). Patients with at least one level of more than 7 ng/mL were considered to have a positive enzyme study. The in-hospital diagnosis of AMI was determined by the development of typical serial ECG changes or separate standard cardiac enzyme changes after admission. SETTING: Eight tertiary-care medical center hospitals. METHODS AND MAIN RESULTS: Of the 616 study patients, 108 (17.5%) were diagnosed in the hospital as AMI; 69 of these AMI patients (63.9%) had nondiagnostic ECGs in the ED. Of the patients with nondiagnostic ECGs, 55 (sensitivity, 79.7%) had a positive ED serial CK-MB enzyme study within three hours after presentation. Combining serial ED CK-MB assay results with diagnostic ECGs yielded an 88.4% sensitivity for AMI detection within three hours of ED presentation. The predictive value of a negative serial ED enzyme study for no AMI was 96.2% (specificity, 93.7%). CONCLUSION: Serial CK-MB determination in the ED can help identify AMI patients with initial nondiagnostic ECGs. Use of serial CK-MB analysis may facilitate optimal in-hospital disposition and help guide therapeutic interventions in patients with suspected AMI despite a nondiagnostic ECG.  相似文献   

5.
The diagnostic sensitivity and performance of immunoenzymometric measurements of creatine kinase (CK)-MB mass concentrations in the early diagnosis of acute myocardial infarction (AMI) were examined and compared with the sensitivities and performances of CK and CK-MB activity, in the context of simultaneous measurements of CK, CK-MB activity, and CK-MB mass concentrations in serially drawn blood samples obtained immediately from 36 patients with AMI and 126 patients with chest pain on admission to the emergency room of the department of internal medicine. In the 36 patients with AMI, who were all admitted no later than 4 hours after the onset of chest pain, pathologic increase occurred significantly earlier in CK-MB mass than in both CK and CK-MB activity, with a median difference of 1 hour each. In patients coming to the emergency room (51 with AMI, 51 with angina pectoris and 24 with chest pain not related to coronary artery disease), CK-MB mass was the best diagnostic measurement for AMI of all markers tested (significantly higher efficiency, Youden index and likelihood ratio than both CK and CK-MB activity). Before initiating thrombolytic therapy, the sensitivity of CK-MB mass is significantly higher than CK-MB activity during the 0- to 6-hour period and significantly higher than CK activity during the 2- to 4-hour period after the onset of chest pain. Consequently, it is often possible to diagnose an AMI on the basis of increased CK-MB mass concentrations even at a time when CK and CK-MB activities are still within the reference interval.  相似文献   

6.
OBJECTIVE: To analyze the value of early resting myocardial perfusion gated-SPECT in patients with chest pain and non-diagnostic ECG in the emergency department. PATIENTS AND METHOD: 222 patients (49% women, mean age 61 [13] years) with atypical chest pain and with non-diagnostic ECG were randomized into two groups. Group A comprised 111 patients in whom early resting myocardial perfusion gated-SPECT (<6 hours since the end of chest pain) was performed and CK-MB mass and troponin I were determined at 0, 4 and 8 hours. Group B comprised 111 patients with conventional management in the emergency department without gated-SPECT. RESULTS: Myocardial perfusion gated-SPECT was positive in all 8 patients with increased levels of CK-MB mass and troponin I. This corresponded to a sensitivity and a negative predictive value of 100% for the diagnosis of AMI. Specificity was 84% and positive predictive value was 33% when doubtful results were considered as negative. The number of patients admitted (18.4% vs 32.7%, P<.027) and length of stay (13 [6] hours vs 15.9 [8.6] hours, P<.009) in the emergency department were lower in group A. CONCLUSIONS: In patients with atypical chest pain and non-diagnostic ECG in the emergency department, early resting gated-SPECT was highly sensitive and showed good negative predictive value for the diagnosis of AMI, but positive predictive value was low. This technique may reduce the number of hospitalized patients and length of stay in the emergency department.  相似文献   

7.
STUDY OBJECTIVES: Patients presenting to the emergency department with chest discomfort are a difficult problem for emergency physicians. Nearly 50% of patients with acute myocardial infarction (AMI) will initially have nondiagnostic ECGs on ED presentation. The purpose of this study was to determine if patients with AMI having nondiagnostic ECGs could be identified using new immunochemical assays for serial CK-MB sampling in the ED. DESIGN: Chest pain patients, more than 30 years old, with pain not caused by trauma or explained by radiographic findings, were eligible for the study. Serial serum samples were drawn on ED presentation (zero hours) and three hours after presentation, then analyzed for CK-MB using four immunochemical methods and electrophoresis. Standard World Health Organization criteria were used to establish the diagnosis of AMI, including new Q-wave formation or elevation of standard in-hospital serum cardiac enzyme markers. SETTING: A tertiary cardiac care community hospital. MEASUREMENTS AND MAIN RESULTS: The serum from 183 patients hospitalized for possible ischemic chest pain was collected and analyzed. Thirty-one of 183 patients (17%) were found to have AMI by standard in-hospital criteria. Sixteen of the 31 patients (52%) with AMI had nondiagnostic ECGs on presentation. Immunochemical determination of serial CK-MB levels provided a sensitive and specific method for detecting AMI in patients within three hours after ED presentation compared with standard electrophoresis. The four immunochemical methods demonstrated a range in sensitivity from 50% to 62.1% on ED presentation versus 92% to 96.7% three hours later. The immunochemical tests demonstrated specificities ranging from 83.0% to 96.4% at three hours, with three of the four tests having specificities of 92% or greater. Electrophoresis had a sensitivity of 34.5% on ED presentation, increasing to 76.9% at three hours, with a specificity of 98.6%. CONCLUSIONS: Immunochemical CK-MB methods allowed rapid, sensitive detection of AMI in the ED. Early detection of AMI offers many potential advantages to the emergency physician. Early detection of AMI, while the patient is in the ED, could direct disposition of this potentially unstable patient to an intensive care setting. Such information may prevent the ED discharge of patients with AMI having nondiagnostic ECGs. The diagnosis of AMI within a six-hour period after symptom onset may allow thrombolytic therapy to be given to patients with AMI not having diagnostic ECGs. This study served as a pilot trial for a multicenter study of the Emergency Medicine Cardiac Research Group, which is currently ongoing.  相似文献   

8.
目的探讨心肌肌钙蛋白T(cTnT)快速检测对急性心肌梗死(AMI)的早期诊断和不良后果预测价值.方法对123名高度可疑的AMI患者在发病后24小时内系列检测cTnT和肌酸激酶同工酶MB(CK-MB)活性.结果 (1)在发病后6小时、12小时和24小时内cTnT检测AMI的敏感性分别为38.8%、85.4%和94.2%,特异性为100%;(2)在发病后6小时和24小时内,CK-MB(活性)检测AMI的敏感性分别为70%和77.7%;(3)AMI患者随着cTnT水平升高,30天死亡率显著增加(P<0.01).结论 cTnT快速检测对诊断AMI具有高度的敏感性和特异性,并能预测患者的不良后果.该方法简单快速,适宜床边检测.  相似文献   

9.
Cardiac troponin T(cTnT) is one of the most myocardial-specific markers for the diagnosis of acute myocardial infarction(AMI). Recently, the rapid bedside cTnT assay(Trop T rapid assay sensitive version), which can provide qualitative determinations within 15 min, has been developed for the emergency clinical setting. To evaluate the usefulness of rapid bedside cTnT assay, we performed the Trop T test and measured serum levels of myoglobin(Mb), creatine kinase MB isoenzyme(CK-MB) and cTnT in 256 consecutive emergency patients with suspected AMI(65 found to have AMI and 191 without AMI). The diagnostic sensitivities for AMI of Trop T, Mb and CK-MB measurements were 66%, 92% and 52%, respectively, whereas the specificities were 80%, 18% and 74%, respectively. The diagnostic accuracy for AMI of Trop T(77%) was significantly higher than that of Mb(37%, p < 0.001) and CK-MB(69%, p < 0.05). The sensitivity for AMI of Mb(86%) was significantly(p < 0.001) higher than that of Trop T (31%) and CK-MB(31%) in patients admitted < or = 3 hr after the onset of AMI. In contrast, the sensitivities of Trop T(80% and 100%) in patients admitted at 3-6 hr and > 6 hr showed no significant differences from those of Mb(100% and 96%). Furthermore, Trop T in patients admitted > 6 hr had significantly(p < 0.01) higher sensitivity compared with CK-MB(69%). The mortality rate in the non-AMI group during hospitalization in patients with positive Trop T test(39%) was significantly(p < 0.001) higher than that in patients with negative test(9%). When the positive Trop T test was regarded as > or = 0.10 ng/ml of serum cTnT, Trop T test had the best concordance of 92% with a quantitative of cTnT assay.  相似文献   

10.
STUDY OBJECTIVE: To analyze the effect of creatine kinase isoenzyme (CK-MB) results on decision making in the evaluation of emergency department patients with chest pain. DESIGN: Prospective, controlled observational study of clinical decision making. SETTING: EDs of two teaching hospitals, a Veterans Affairs medical center, and a medical school university hospital. TYPE OF PARTICIPANTS: Patients more than 30 years old complaining of chest discomfort warranting an ECG. Excluded were hemodynamically unstable patients and patients with ECG evidence of an acute myocardial infarction (AMI). INTERVENTIONS: After the initial assessment including ECG but not CK-MB data, physicians answered questions regarding estimated probability of AMI and disposition plans. CK-MB levels were drawn every hour for as long as three hours (from one to four CK-MBs) with results readily available. Physicians could admit their patients into the hospital at any time. At disposition after reviewing a second ECG and all available CK-MB data, the physicians answered the same questions and rank ordered the contribution to disposition of the following six factors: initial and serial clinical evaluations, initial and serial ECGs, and initial and serial CK-MB enzymes, respectively. The absolute log likelihood ratio test measured the contribution of CK-MB to decision certainty. MEASUREMENTS AND MAIN RESULTS: Three hundred seventy-six patients were studied: 29 (7.7%) with AMI and 347 without AMI (nonAMI). Physicians indicated that CK-MB levels were useful for more than one third of study patients. When considered useful, CK-MB results strengthened the impression of AMI in AMI patients and decreased the impression of AMI for nonAMI patients; CK-MB also correlated with the perceived need for cardiac care unit admission in AMI patients and with a reduced need to admit nonAMI patients. The use of CK-MB results did not significantly increase ED release rates. CONCLUSION: The rapid availability of serial CK-MB results appears to affect decision making in one third of ED patients with chest pain and nondiagnostic ECGs. CK-MB levels appear to complement clinical evaluation of the ED chest pain patient in a manner analogous to the ECG.  相似文献   

11.
BACKGROUND: Although redefinition for acute myocardial infarction (AMI) has been proposed few years ago, to date it has not been universally adopted by many institutions. The purpose of this study is to evaluate the diagnostic, prognostic and economical impact of the new diagnostic criteria for AMI. METHODS: Patients consecutively admitted to the emergency department with suspected acute coronary syndromes were enrolled in this study. Troponin T (cTnT) was measured in samples collected for routine CK-MB analyses and results were not available to physicians. Patients without AMI by traditional criteria and cTnT > or = 0.035 ng/mL were coded as redefined AMI. Clinical outcomes were hospital death, major cardiac events and revascularization procedures. In-hospital management and reimbursement rates were also analyzed. RESULTS: Among 363 patients, 59 (16%) patients had AMI by conventional criteria, whereas additional 75 (21%) had redefined AMI, an increase of 127% in the incidence. Patients with redefined AMI were significantly older, more frequently male, with atypical chest pain and more risk factors. In multivariate analysis, redefined AMI was associated with 3.1 fold higher hospital death (95% CI: 0.6-14) and a 5.6 fold more cardiac events (95% CI: 2.1-15) compared to those without AMI. From hospital perspective, based on DRGs payment system, adoption of AMI redefinition would increase 12% the reimbursement rate [3552 Int dollars per 100 patients evaluated]. CONCLUSIONS: The redefined criteria result in a substantial increase in AMI cases, and allow identification of high-risk patients. Efforts should be made to reinforce the adoption of AMI redefinition, which may result in more qualified and efficient management of ACS.  相似文献   

12.
OBJECTIVESWe compared the predictive properties of P-selectin to creatine kinase, MB fraction (CK-MB) for detecting acute myocardial infarction (AMI), acute coronary syndromes (ACS) and serious cardiac events upon emergency department (ED) arrival.BACKGROUNDPractioners detecting early diagnosis of ACS have focused on cardiac markers of myocardial injury. Plaque rupture/platelet aggregation precedes myocardial ischemia. Therefore, markers of platelet aggregation may detect ACS earlier than cardiac markers.METHODSConsecutive patients with potential ACS presenting to an urban university ED were identified by research assistants who screened all ED patients between November 12, 1997 and January 31, 1998. Whole blood was drawn at presentation and 1 h later and rapidly stained and fixed for membrane P-selectin assay and plasma was separated for soluble P-selectin assay. Creatine kinase, MB fraction values were determined using standard immunoassay techniques. Clinical history and hospital course were followed daily. Outcomes were AMI, ACS (AMI and unstable angina) and serious cardiac events. Receiver operator characteristic curves were derived for CK-MB, and soluble and membrane-bound P-selectin to determine the optimal cutoff values. Predictive properties were calculated with 95% confidence intervals.RESULTSA total of 263 patients were enrolled. They had a mean age of 56.5 ± 14 years; 52% were male. There were 22 patients with AMI; 87 patients with ACS and 54 patients with serious cardiac events. Creatine kinase, MB fraction had a higher specificity for detection of AMI, ACS and serious cardiac events than both soluble and membrane-bound P-selectin. At the time of ED presentation, the specificity of CK-MB, and soluble and membrane-bound P-selectin for AMI was 91% versus 76% versus 71%; for ACS, 95% versus 79% versus 71%, and for serious cardiac events, 91% versus 76% versus 72% (p < 0.05). The sensitivities for AMI were 50% versus 45% versus 32%; for ACS, 26% versus 35% versus 30%, and for serious cardiac events, 29% versus 35% versus 36%.CONCLUSIONSAlthough theoretically attractive, the use of soluble and membrane-bound P-selectin for risk stratification of chest pain patients at the time of ED presentation does not appear to have any advantages over the use of CK-MB.  相似文献   

13.
The early presence of troponin T in serum strongly predicts short-term mortality and myocardial infarction in patients with acute coronary syndromes. We investigated the long-term outcome of the prognostic significance of the troponin T rapid bedside assay (TROPT) and compared this with the quantitative troponin T assay (cTnT enzyme-linked immunosorbent assay), myoglobin and creatine kinase-MB (CK-MB) mass. One hundred sixty-three patients with chest pain and suspected acute coronary syndromes were studied and followed prospectively for 3 years. Serial blood specimens were obtained at admission and at 3, 6, 12, 24, 48, 72, and 96 hours after admission. Patients were classified as having acute myocardial infarction in 99 patients (61%), unstable angina in 34 patients (21%), and no evidence for acute cardiac ischemia in 30 patients (18%). At 3 years, 28 patients (17%) had died of which 25 deaths (15%) were for cardiac reasons. Twenty-one patients (13%) had a nonfatal (recurrent) myocardial infarction. At admission 29% of the patients were TROPT positive (> or = 0.2 microg/L), another 31% became positive within 12 hours, and 39% remained negative. When adjusted for baseline variables, a positive TROPT (any sample 0 to 12 hours) was independently associated with a higher risk of cardiac mortality (RR 4.3, 95% confidence interval [CI] 1.3 to 14.0). Because troponin T stays elevated up to 2 weeks, later TROPT results between 24 and 96 hours remained significantly predictive for mortality. The cTnT enzyme-linked immunosorbent assay (any sample 0 to 12 hours; cutoff > or = 0.2 microg/L) was similarly predictive (RR 2.9, 95% CI 1.0 to 8.6). Early myoglobin results were significantly prognostic for cardiac mortality up to 12 hours after admission (RR 3.7; 95% CI 1.0 to 12.0). In contrast, serial CK-MB mass measurements were not predictive of mortality. Thus, a combination of a baseline TROPT and an additional TROPT 12 hours or later identifies a subgroup of patients at high risk for subsequent mortality and reinfarction, both at short-term but also at long-term.  相似文献   

14.
STUDY OBJECTIVE: We determine the overall use of a 6-step accelerated chest pain protocol to identify and exclude acute coronary syndrome (ACS) and to confirm previous findings of the use of serial 12-lead ECG monitoring (SECG) in conjunction with 2-hour delta serum marker measurements to identify and exclude acute myocardial infarction (AMI). METHODS: A prospective observational study was conducted over a 1-year period from January 1, 1999, through December 31, 1999, in 2,074 consecutive patients with chest pain who underwent our accelerated evaluation protocol, which includes 2-hour delta serum marker determinations in conjunction with automated SECG for the early identification and exclusion of AMI and selective nuclear stress testing for identification and exclusion of ACS. In patients not undergoing emergency reperfusion therapy, physician judgment was used to determine patient disposition at the completion of the 2-hour evaluation period: admit for ACS, discharge or admit for non-ACS condition, or immediate emergency department nuclear stress scan for possible ACS. A positive protocol was defined as a positive result in 1 or more of the 6 incremental steps in our chest pain evaluation protocol: (1) initial ECG diagnostic of acute injury or reciprocal injury; (2) baseline creatine kinase (CK)-MB level of 10 ng/mL or greater and index of 5% or greater or cardiac troponin I level of 2 ng/mL or greater; (3) new/evolving injury or new/evolving ischemia on SECG; (4) increase in CK-MB level of +1.5 ng/mL or greater or cardiac troponin I level of +0.2 ng/mL or greater in 2 hours; (5) clinical diagnosis of ACS despite a negative 2-hour evaluation; and (6) reversible perfusion defect on stress scan compared with on resting scan. All patients were followed up for 30-day ACS, which was defined as myocardial infarction (MI), percutaneous coronary intervention/coronary artery bypass grafting, coronary arteriography revealing stenosis of major coronary artery of 70% or greater not amenable to percutaneous coronary intervention/coronary artery bypass grafting, life-threatening complication, or cardiac death within 30 days of ED presentation. RESULTS: Discharge diagnosis in the 2,074 study patients consisted of 179 (8.6%) patients with AMI, 26 (1.3%) patients with recent AMI (decreasing curve of CK-MB), and 327 (15.8%) patients with 30-day ACS. At 2 hours, sensitivity and specificity for MI (AMI or recent AMI) of SECG plus delta serum marker measurements was 93.2% and 93.9%, respectively (positive likelihood ratio 15.3; negative likelihood ratio 0.07). At the completion of the full ED evaluation protocol (positive result in >or=1 of the 6 incremental steps), sensitivity and specificity for 30-day ACS was 99.1% and 87.4%, respectively (positive likelihood ratio 7.9; negative likelihood ratio 0.01). CONCLUSION: An accelerated chest pain evaluation strategy consisting of SECG, 2-hour delta serum marker measurements, and selective nuclear stress testing in conjunction with physician judgment identifies and excludes MI and 30-day ACS during the initial evaluation of patients with chest pain.  相似文献   

15.
Diagnostic marker cooperative study for the diagnosis of myocardial infarction   总被引:27,自引:0,他引:27  
BACKGROUND: Millions of patients present annually with chest pain, but only 10% to 15% have myocardial infarction. Lack of diagnostic sensitivity and specificity of clinical and conventional markers prevents or delays treatment and leads to unnecessary costly admissions. Comparative data are lacking on the new markers, yet using all of them is inappropriate and expensive. METHODS AND RESULTS: The Diagnostic Marker Cooperative Study was a prospective, multicenter, double-blind study with consecutive enrollment of patients with chest pain presenting to the emergency department. Diagnostic sensitivity and specificity and frequency of increase in patients with unstable angina were determined for creatine kinase-MB (CK-MB) subforms, myoglobin, total CK-MB (activity and mass), and troponin T and I on the basis of frequent serial sampling for 相似文献   

16.
目的 :探讨新的生化标记物对急性心肌梗死 (AMI)早期诊断价值。  方法 :动态监测 98例AMI患者血清肌红蛋白 (Mb) ,心肌肌钙蛋白I、T (cTnI、cTnT )及肌酸激酶MB同工酶(CK MB)的变化 ,对比分析它们对AMI的早期诊断及对预后的判断。  结果 :AMI起病 6小时之内 ,以Mb诊断敏感性最高 (90 2 0 % ) ,cTnI次之 (5 2 94% ) ,CK MB最低 (2 7 45 % ) ;cTnI和cTnT升高显著且较长时间不降者预后差。  结论 :早期确诊或排除AMI以cTnI和Mb组合更为可取 ;判断溶栓是否再通以cTnI和CK MB更为准确可靠 ;对那些心肌损伤标记物升高显著 ,且较长时间居高不降者 ,提示预后欠佳。  相似文献   

17.
OBJECTIVES

The purpose of this study was to demonstrate the safety and utility of immediate exercise treadmill testing (IETT) of low risk patients presenting to the emergency department with known coronary artery disease (CAD).

BACKGROUND

More than 70% of the two million patients admitted to U.S. hospitals annually for suspected acute myocardial infarction (AMI) are found not to have had a cardiac event. We have previously demonstrated the safety and efficacy of IETT of selected low risk patients without known CAD presenting to the emergency department with chest pain. This study extends this approach to selected patients with a history of CAD.

METHODS

One hundred patients evaluated by the chest pain emergency room to rule out AMI underwent IETT using a modified Bruce protocol upon admission to the hospital (median time <1 h).

RESULTS

Twenty-three patients (23%) had positive exercise electrocardiograms (ExECGs); an uncomplicated non–Q wave AMI was diagnosed in two patients. Thirty-eight patients (38%) had negative ExECGs and 39 patients (39%) had nondiagnostic ExECGs. Of these 100 patients, 64 were discharged immediately after IETT, 19 were discharged in less than 24 h after negative serial cardiac enzymes and stable electrocardiograms and 17 were discharged after further evaluation and treatment. There were no complications from exercise testing and no late deaths or AMI during six-month follow-up.

CONCLUSIONS

Immediate exercise treadmill testing of low risk patients with chest pain and known CAD is effective in further stratifying this group into patients who can be safely discharged and those who require hospital admission.  相似文献   


18.

Objective

To assess the role of Copeptin in diagnosis of acute myocardial infarction in troponin-blind period.

Subjects and methods

This study was conducted on 40 patients who presented to emergency department complaining of chest pain and were highly suspicious to have acute cardiac ischemia, in addition to 10 subjects serving as a healthy control group. Blood samples were collected for determination of CK-MB, cTnI and Copeptin. These were measured twice (in patients’ group); at 3 h and then at 6–9 h from admission time.

Results

The first sample revealed a non-significant difference between UA group and AMI group as regards CKMB and troponin, however, high significant difference was found as regards Copeptin (Z?=?5.29, P?<?0.001). Moreover, ROC curve analysis of serum Copeptin for discriminating AMI group from UA group in the first sample showed diagnostic sensitivity and specificity of 100%.

In conclusion

Determination of copeptin in early diagnosis of AMI has diagnostic value being superior to a conventional cTn-I within the first three hours after acute chest pain.  相似文献   

19.
心肌脂肪酸结合蛋白对早期急性心肌梗死的诊断   总被引:9,自引:1,他引:8  
目的研究血浆心肌脂肪酸结合蛋白(HFABP)在早期急性心肌梗死(AMI)诊断中的价值。方法选择93例发病6h内的胸痛患者,其中AMI组32例,非AMI组61例[含不稳定型心绞痛(UAP)24例,稳定型心绞痛(SAP)者22例,非心源性胸痛者15例];正常对照组选择69例正常人。采用双抗体夹心酶联免疫一步法检测正常人和患者发病0~3h或3~6h血浆的HFABP含量,并与心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CKMB)和肌红蛋白(MYO)的检测结果进行比较,分析4种生化标志物诊断发病3h内和6h内AMI的敏感性、特异性和准确性。结果在0~3h、0~6h时间段,HFABP诊断AMI的敏感性(64.29%、84.38%)显著高于cTnI(28.57%、53.13%)和CKMB(21.43%、56.25%),与MYO(71.43%、78.13%)比较差异无统计学意义;在诊断特异性上,4种生化标志物差异无统计学意义;在诊断准确性上,HFABP的ROC曲线下面积(0.979、0.958)显著高于cTnI(0.800、0.878)、CKMB(0.575、0.782)和MYO(0.796、0.882)。结论HFABP对于诊断早期AMI具有较高的敏感性和良好的特异性,其诊断准确性优于cTnI、CKMB、MYO。  相似文献   

20.
AIM: To describe the characteristics and outcome of patients who came to the emergency department due to chest pain or other symptoms raising suspicion of acute myocardial infarction (AMI) in relation to whether they were hospitalized or directly discharged from the emergency department. METHODS: All patients arriving to the emergency department in one single hospital due to chest pain or other symptoms raising suspicion of AMI during a period of 21 months were followed for 10 years. RESULTS: In all, 5362 patients fulfilled the given criteria on 7157 occasions; 3381 (63%) were hospitalized and 1981 (37%) were directly discharged. Patients who were hospitalized were older and had a higher prevalence of previous cardiovascular diseases. The mortality during the subsequent 10 years was 52.1% among those hospitalized and 22.3% among those discharged (P < 0.0001). Risk indicators for death were similar in the two cohorts. However, many of these risk indicators including age, a history of myocardial infarction, angina pectoris, congestive heart failure, hypertension, initial degree of suspicion of AMI, a pathologic electrocardiogram on admission and a confirmed AMI as underlying etiology were more strongly associated with the prognosis among patients directly discharged than among those hospitalized. Ten (0.5%) of the patients who were directly discharged from the emergency department were found to have a diagnosis of confirmed or possible AMI, making up 1% of all patients given such a diagnosis. These patients had a 10-year mortality of 80.0% compared with 65.7% among patients with a confirmed or possible AMI who were hospitalized. CONCLUSION: Of patients who came to the emergency department with acute chest pain or other symptoms suggestive of AMI about a third were directly discharged. Their mortality during the subsequent 10 years was half that of patients hospitalized. Various risk indicators for death were more strongly associated with prognosis in the patients who were directly discharged from the emergency department compared to those hospitalized. Of all patients given a diagnosis of confirmed or possible AMI, 1% were discharged from the emergency department. Their long-term mortality was high, maybe even higher than among AMI patients hospitalized.  相似文献   

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