Diagnostic accuracy of myoglobin concentration for the early diagnosis of acute myocardial infarction
Diagnostic accuracy of myoglobin concentration for the early diagnosis of acute myocardial infarction
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DOI：
10.1016/s0196-0644(00)70129-6
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发表时间：
2000-02-01
影响因子：
6.2
通讯作者：
Sanders, GT
中科院分区：
文献类型：
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作者：
de Winter, RJ;Lijmer, JG;Sanders, GT
研究目的：评价肌红蛋白测定在急性心肌梗死(AMI)早期诊断中的准确性。结果：共纳入309例患者，其中162例确诊为急性心肌梗死。ROC分析显示，以ROC曲线下面积(AUC)表示的肌红蛋白浓度诊断准确率从发病后3h(0.89±-0.026)和4h(0.93+/-0.019)显著提高到5h(0.96+/-0.014；P=0.0040和0.035)。以肌红蛋白90mU g/L为临界值时，敏感性为95%(95%可信区间90%~98%)，特异度为86%(95%可信区间80%~93%)。结论：肌红蛋白对急性心肌梗死起病5h的诊断具有最高的诊断准确率，以50mU g/L为临界值，结合其他生化指标的检测，肌红蛋白诊断急性心肌梗死的准确率最高。肌红蛋白测定对急性心肌梗死患者的早期分诊特别有用。
Study objective: We evaluated the diagnostic accuracy of myoglobin determination for the early diagnosis of acute myocardial infarction (AMI).Methods: Consecutive patients with chest pain were included in the study. Receiver operating characteristic (ROC) analysis was used to assess optimal timing of blood sampling and cutoff values.Results: A total of 309 patients were included, of whom 162 patients had a diagnosis of AMI. ROC analysis revealed that the diagnostic accuracy of myoglobin concentration as indicated by the area under the ROC curve (AUC) increased significantly from 3 (0.89+/-0.026) and 4 hours (0.93+/-0.019) to 5 hours after onset of symptoms (0.96+/-0.014; P=.0040 and .035, respectively). At 5 hours (the earliest time point with maximal AUC), sensitivity was 87% and specificity was 97% using a myoglobin cutoff value of 90 mu g/L. With a myoglobin cutoff value of 50 mu g/L, sensitivity was 95% (95% confidence interval 90% to 98%), but specificity was 86% (95% confidence interval 80% to 93%).Conclusion: Myoglobin has maximal diagnostic accuracy for the diagnosis of AMI at 5 hours after the onset of symptoms, using a cutoff value of 50 mu g/L. In combination with the measurement of other biochemical markers, myoglobin determination could be particularly useful for triage of patients with AMI at an early stage.