Could Troponin Ⅰ Elevations Predict Acute Myocardial Infarction? A 3-Year Retrospective Analysis of Acute Myocardial Infarction Patients at a Taiwan Hospital

Troponin Ⅰ的升高是否可以預測急性心肌梗塞呢？－經由急診入院的急性心肌梗塞病人在某中部醫學中心之三年回顧分析

簡凱偉(Kai-Wei Chien) ； 吳漢屏(Han-Ping Wu) ； 張玉君(Yu-Jun Chang) ； 李明和(Ming-Ho Lee) ； 張進富(Chin-Fu Chang) ； 周志中(Chu-Chung Chou)

《Journal of Emergency Medicine, Taiwan》 8卷2期 (2006/06) Pp. 31-36

摘要

目的：這研究的目的為了建立一個臨床上可以應用的troponin Ⅰ預測性的切割值，當為急診室急性心肌梗塞早期診斷出的預測值。
方法：共收集了從2003年三月到2005年二月連續性地從彰化基督教醫院急診住院共5624位病人，他們都是有胸痛症狀並有急性冠狀動脈心臟病。最後的診斷則是根據出院病歷上的記載。詳細的實驗室數據則是來自檢驗醫學部。而住院的標準是根據troponin Ⅰ大於0.04 mg/L並與初步臆測是急性冠狀動脈心臟病。Receiver operating characteristic curves用來預測急性心肌梗塞時troponin Ⅰ的切割值。
結果：在出院時，全部共有256個病人(256/5624)被診斷是急性心肌梗塞。這些病人平均是75.57歲。跟診斷有關的五個變數分別是年齡、CPK、CK-MB、GPT和troponin Ⅰ。而troponin Ⅰ的ROC曲線顯示最好的切割點是在於0.042 mg/L。在那個切點值的敏感度是0.824與專一度是0.816來作為區別診斷。
結論：我們建議用troponin Ⅰ值為0.042 mg/L當作診斷為急性心肌梗塞的切割值。

關鍵字

急性心肌梗塞 ； 胸痛 ； 心臟酵素 ； troponin Ⅰ ； 切割值

並列摘要

Objective: The purpose of this study is to establish a clinically applicable cut off value of troponin Ⅰ that can be used for determining the early diagnosis in patients with acute myocardial infarction (AMI) in the emergency department.
Methods: The medical records of 5,624 emergency admission patients with chest pain and clinically suspected acute coronary syndrome (ACS) were enrolled consecutively in this study between Mar 2003 and Feb 2005 at the Changhua Christian Hospital. The final diagnoses were based on what was recorded on the discharge notes. Detailed laboratory data were from the department of laboratory medicine. The criterion for admission was a troponin measurement larger than 0.04mg/L, in addition to initial clinical impression of ACS. Receiver operator characteristic analyses were performed to determine cut off points of troponin Ⅰ in prediction of AMI.
Results: A total of 256 patients (256/5624) were diagnosed with AMI upon discharge. Their mean age was 75.57 years. The 5 variables associated with the diagnosis were age, CPK, CK-MB, GPT, and troponin Ⅰ. The best cut off point revealed by the ROC curve of troponin Ⅰ was 0.042 mg/L; at which the sensitivity was 0.824 and the specificity was 0.816 when used for differential diagnosis.
Conclusion: We recommend that the cut off value of troponin Ⅰ level at 0.042 mg/L may serve as a predictive parameter in the diagnosis of AMI.

並列關鍵字

acute myocardial infarction ； chest pain ； cardiac enzyme ； troponin Ⅰ ； cut off value