Multicentre evaluation of the diagnostic value of cardiac troponin T, CK-MB mass, and myoglobin for assessing patients with suspected acute coronary syndromes in routine clinical practice
Multicentre evaluation of the diagnostic value of cardiac troponin T, CK-MB mass, and myoglobin for assessing patients with suspected acute coronary syndromes in routine clinical practice
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DOI：
10.1136/heart.89.3.280
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发表时间：
2003-03-01
期刊：
影响因子：
5.7
通讯作者：
Kessler, AC
中科院分区：
文献类型：
--
作者：
Collinson, PO;Stubbs, PJ;Kessler, AC
目的：评估第三代心肌肌钙蛋白T检测在常规临床实践中的诊断效率。设计：对10例连续入院患者进行前瞻性观察研究。设置：在13个国家的43家教学和非教学医院进行的多中心研究。受试者：1105例住院，中位年龄67岁（15-96岁，63.7%男性）疑似急性冠脉综合征（72.3%的病例）或需要排除心脏病的其他非特异性症状干预措施：在研究期间，肌红蛋白、肌酸激酶MB同工酶（CK-MB）和心肌肌钙蛋白T与常规诊断测试平行测量。最终诊断分类涉及标准ECG变化和CK-MB质量超过5.0 mug/l。主要结果测量：诊断效率通过受试者操作特征曲线分析评估，包括和排除不稳定型心绞痛患者。心肌肌钙蛋白T的测量在诊断上等同于CK-MB，两者均优于肌红蛋白，12小时曲线下面积分别为0.94，0.99，分别为0.80。当纳入不稳定型心绞痛患者时，使用CK-MB的诊断标准是不充分的，并显示偏倚。心肌肌钙蛋白T的升高没有发生心脏疾病时，可以被明确排除，但被发现在临床条件以外的怀疑急性冠脉syndrome.Conclusions：CK-MB是不合适的诊断金标准，即使在建议的较低阈值。心肌肌钙蛋白T的较低临界值0.05 μ g/l应用于诊断急性心肌梗死。急性心肌梗死的诊断不能仅根据心肌肌钙蛋白T结果。
Objective: To assess the diagnostic efficiency of the third generation cardiac troponin T assay in routine clinical practice.Design: Prospective observational study of unselected consecutive admissions.Setting: Multicentre study in 43 teaching and non-teaching hospitals in 13 countries.Subjects: 1105 hospital admissions, median age 67 years (range 15-96 years, 63.7% male) with suspected acute coronary syndromes (72.3% of cases) or other non-specific symptoms where cardiac disease required exclusion (27.7%).Interventions: Over the study period, myoglobin, creatine kinase MB isoenzyme (CK-MB), and cardiac troponin T where measured in parallel with conventional diagnostic tests. Final diagnostic classification involved standard ECG changes and CK-MB mass exceeding 5.0 mug/l.Main outcome measures: Diagnostic efficiency was assessed by receiver operator characteristic curve analysis including and excluding patients with unstable angina.Results: Measurement of cardiac troponin T was diagnostically equivalent to CK-MB and both were better than myoglobin, with areas under the curve at 12 hours of 0.94, 0.99, and 0.80, respectively. Diagnostic criteria using CK-MB were inadequate and showed bias when patients with unstable angina were included. Elevations of cardiac troponin T did not occur when cardiac disease could be categorically excluded but were found in clinical conditions other than suspected acute coronary syndromes.Conclusions: CK-MB is unsuitable as a diagnostic gold standard even at the proposed lower threshold. A lower cut off for cardiac troponin T of 0.05 mug/l should be used for diagnosis of acute myocardial infarction. Diagnosis of acute myocardial infarction cannot be made solely on the basis of a cardiac troponin T result.