Comparison of the value of novel rapid measurement of myoglobin, creatine kinase, and creatine kinase-MB with the electrocardiogram for the diagnosis of acute myocardial infarction.
Comparison of the value of novel rapid measurement of myoglobin, creatine kinase, and creatine kinase-MB with the electrocardiogram for the diagnosis of acute myocardial infarction.
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新型快速测量肌红蛋白、肌酸激酶和肌酸激酶-MB与心电图诊断急性心肌梗死的价值比较。
DOI：
10.1136/hrt.71.4.311
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发表时间：
1994
影响因子：
--
通讯作者：
K. Jennings
中科院分区：
文献类型：
--
作者：
H. S. Lee;S. Cross;P. Garthwaite;A. Dickie;I. Ross;S. Walton;K. Jennings
目的--确定入院时通过快速、紧凑和易于使用的自动定量分析仪（10分钟内得出结果）测量的血清肌红蛋白、肌酸激酶和肌酸激酶MB是否有助于早期识别急性心肌梗死。结果与入院时记录的心电图数据进行比较。设计--前瞻性研究。环境--冠心病监护病房。患者--94例疑似心肌梗死的连续患者。随后在44例患者中证实了心肌梗死，并在50例患者中排除了心肌梗死。方法：所有入院患者的血清肌红蛋白、肌酸激酶和肌酸激酶MB均由临床工作人员在冠心病监护室使用分析仪进行测定。所有患者均获得入院心电图。结果：诊断心肌梗死的敏感性、特异性和预测准确性分别为：心电图68%、100%和85%;肌红蛋白57%、100%和80%;肌酸激酶（阈值为190 U/l）34%、98%和68%;肌酸激酶MB（阈值为25 U/l）43%、100%和73%。当心电图和肌红蛋白数据相结合时，敏感性提高到91%，诊断准确性提高到96%，特异性为100%。心电图和肌酸激酶MB的诊断符合率分别为80%、90%、100%，心电图联合肌酸激酶的诊断符合率分别为80%、89%、98%。结论：入院时肌红蛋白、肌酸激酶和肌酸激酶同工酶测定对急性心肌梗死的诊断不如心电图有用。结合心电图和肌红蛋白数据大大提高了急性心肌梗死诊断的敏感性和预测准确性。
OBJECTIVE--To determine whether serum myoglobin, creatine kinase, and creatine kinase-MB measured at admission by rapid, compact, and easy to use automated quantitative analysers (results within 10 min) helped the early identification of acute myocardial infarction. The results were compared with the data obtained from the electrocardiograms recorded at admission. DESIGN--A prospective study. SETTING--Coronary care unit. PATIENTS--94 consecutive patients with suspected myocardial infarction. Myocardial infarction was subsequently confirmed in 44 patients and excluded in 50. METHODS--All admission serum myoglobin, creatine kinase, and creatine kinase-MB were measured by clinical staff using analysers in the coronary care unit. An admission electrocardiogram was obtained from all patients. RESULTS--The sensitivity, specificity, and predictive accuracy for diagnosing myocardial infarction were: electrocardiogram 68%, 100%, and 85%; myoglobin 57%, 100%, and 80%; creatine kinase (threshold of 190 U/l) 34%, 98%, and 68%; creatine kinase-MB (threshold of 25 U/l) 43%, 100%, and 73%. When the electrocardiographic and myoglobin data were combined the sensitivity improved to 91%, diagnostic accuracy to 96%, with specificity of 100%. The results for the electrocardiogram and creatine kinase-MB were 80%, 90%, 100% respectively and those for the electrocardiogram with creatine kinase were 80%, 89%, 98% respectively. CONCLUSIONS--Admission myoglobin, creatine kinase, and creatine kinase-MB measurements were not as useful as the electrocardiogram for the diagnosis of acute myocardial infarction. Combining the electrocardiogram and myoglobin data substantially improved the sensitivity and predictive accuracy for the diagnosis of acute myocardial infarction.