Ischaemic heart disease - The universal definition of myocardial infarction: a consensus document
Ischaemic heart disease - The universal definition of myocardial infarction: a consensus document
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DOI：
10.1136/hrt.2008.151233
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发表时间：
2008-10-01
期刊：
影响因子：
5.7
通讯作者：
White, Harvey D.
中科院分区：
文献类型：
--
作者：
Alpert, Joseph S.;Thygesen, Kristian;White, Harvey D.
在医学中，就像在所有人类交流中一样，清晰的定义是必不可少的。医学史上充满了由于对特定疾病实体的定义不佳而导致的沟通失败的例子。在临床实践中，正如在临床科学中一样，对诊断或研究的疾病的明确定义是管理该疾病的最初关键步骤。对疾病实体的准确、清晰的定义使临床医生能够相互沟通，研究疾病，并最终向患者解释患者所患的具体病症。临床科学家的诊断标准也必须准确和可重复，以便研究类似的疾病患者并进入临床试验。当使用准确的、可重复的特定疾病实体定义时，一项临床试验的结果可以与其他试验的结果进行比较，临床医生可以就特定疾病在他们之间进行准确的交流。已经花费了相当大的科学努力来鉴定用于清楚和准确地定义急性缺血性心脏病的各种综合征的实验室工具。其中一种现代工具涉及生物标志物的使用。生物标志物是与临床发现一起使用的连续性测试，以帮助医生做出准确的临床诊断。w1几十年来，各种生物标志物已用于急性缺血性心脏病患者;然而，高度特异性肌钙蛋白检测的出现显著改善了急性缺血性心脏病患者的识别。这些患者的风险分层也通过在日常临床实践中使用肌钙蛋白测量得到帮助。生物标志物肌钙蛋白是迄今为止设计用于识别心肌细胞坏死的最敏感和特异性的测试。使用肌钙蛋白血液检测来定义急性缺血性心脏病的各种综合征已在全球范围内得到应用。目前，在适当的临床环境中，血肌钙蛋白值升高代表了鉴别急性缺血性心肌坏死即急性心肌梗死（MI）的“金标准”。
In medicine, as in all human communication, clear definitions are essential. The history of medicine is filled with examples of communication failures that result when poor definitions of specific disease entities are used. In clinical practice, as in clinical science, a clear definition of the disease diagnosed or studied is the initial, critical step in managing that illness. Accurate, clear definitions of a disease entity enable clinicians to communicate among themselves, to study the disease, and ultimately to explain to patients the specific condition from which the patient suffers. A clinical scientist’s diagnostic criteria must also be accurate and reproducible so that similar patients with the disease are studied and entered into clinical trials. When accurate, reproducible definitions of a specific disease entity are used, results from one clinical trial can be compared with the results from other trials, and clinicians can communicate accurately among themselves concerning a specific disease.BIOMARKERS Given the worldwide importance of morbidity and mortality of cardiovascular disease, considerable scientific effort has been expended in order to identify laboratory tools for clearly and accurately defining the various syndromes of acute ischaemic heart disease. One such modern tool involves the use of biomarkers. Biomarkers are adjunctive tests employed alongside clinical findings to aid physicians in making accurate clinical diagnoses. w1 Various biomarkers have been used for decades in patients with acute ischaemic heart disease; however, the advent of highly specific troponin assays has significantly improved identification of patients with acute ischaemic heart disease. Risk stratification of these patients has also been aided by the use of the troponin measurements in daily clinical practice. The biomarker troponin is the most sensitive and specific test yet devised for identifying myocardial cell necrosis. The use of troponin blood assays to define various syndromes of acute ischaemic heart disease has gained worldwide use. Currently, in an appropriate clinical setting, an elevated blood troponin value represents the ‘‘gold standard’’for identifying acute ischaemic myocardial necrosis—that is, acute myocardial infarction (MI).