Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain
Comparison of myocardial perfusion imaging and cardiac troponin I in patients admitted to the emergency department with chest pain
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DOI：
10.1161/01.cir.99.16.2073
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发表时间：
1999-04-27
期刊：
影响因子：
37.8
通讯作者：
Tatum, JL
中科院分区：
文献类型：
--
作者：
Kontos, MC;Jesse, RL;Tatum, JL
在急诊科可能存在心肌缺血的患者中，很难鉴别出急性冠脉综合征（ACS）患者。心肌灌注显像与Tc-99 m sestamibi和血清心肌肌钙蛋白I（cTnI）的测量都可以识别ACS患者。方法和结果-ACS的低至中度风险的患者进行门控单光子发射CT sestamibi成像和连续心肌标记物测量肌酸激酶MB，总肌酸激酶活性，cTnI超过8小时。阳性灌注成像定义为灌注缺损伴室壁运动异常或增厚。cTnI ≥ 2.0 ng/mL视为异常。在研究的620例患者中，59例（9%）有心肌梗死，81例（13%）有严重的冠状动脉疾病;这些患者中，58例接受了血运重建。灌注显像阳性241例（39%），初始cTnI阳性37例（6%），cTnI ≥ 2.0ng/mL者74例（12%）。灌注显像（92%）与cTnI（90%）检测心肌梗死的敏感性无显著差异，均显著高于初始cTnI（39%）。灌注成像预测血运重建或严重冠状动脉疾病的敏感性显著高于连续cTnI，尽管所有终点的特异性显著较低。降低cTnI的截止值为1.0 ng/mL并没有显着改变的results. Conclusions早期灌注成像和串行cTnI识别心肌梗死具有可比的灵敏度。灌注成像识别了更多接受血运重建或患有严重冠状动脉疾病的患者，但特异性较低。这两项检测可以为识别ACS风险患者提供补充信息。
Background-Identification of patients with acute coronary syndromes (ACS) among those who present to emergency departments with possible myocardial ischemia is difficult. Myocardial perfusion imaging with Tc-99m sestamibi and measurement of serum cardiac troponin I (cTnI) both can identify patients with ACS.Methods and Results-Patients considered at low to moderate risk for ACS underwent gated single-photon emission CT sestamibi imaging and serial myocardial marker measurements of creatine kinase-MB, total creatine kinase activity, and cTnI over 8 hours. Positive perfusion imaging was defined as a perfusion defect with associated abnormalities in wall motion or thickening. cTnI greater than or equal to 2.0 ng/mL was considered abnormal. Among the 620 patients studied, 59 (9%) had myocardial infarction and 81 (13%) had significant coronary disease; of these patients, 58 underwent revascularization. Perfusion imaging was positive in 241 patients (39%), initial cTnI was positive in 37 (6%), and cTnI was greater than or equal to 2.0 ng/mL in 74 (12%), Sensitivity for detecting myocardial infarction was not significantly different between perfusion imaging (92%) and cTnI (90%), and both were significantly higher than the initial cTnI (39%). Sensitivity for predicting revascularization or significant coronary disease was significantly higher for perfusion imaging than for serial cTnI, although specificity for all end points was significantly lower. Lowering the cutoff value of cTnI to 1.0 ng/mL did not significantly change the results.Conclusions-Early perfusion imaging and serial cTnI have comparable sensitivities for identifying myocardial infarction. Perfusion imaging identified more patients who underwent revascularization or who had significant coronary disease, but it had lower specificity. The 2 tests can provide complementary information for identifying patients at risk for ACS.