A Rapid Point-of-Care Cardiac Marker Testing Strategy Facilitates the Rapid Diagnosis and Management of Chest Pain Patients in the Emergency Department

医学 胸痛 急诊科 心肌梗塞 肌钙蛋白I 内科学 心脏病学 心脏标志物 肌酸激酶 肌钙蛋白 检测点注意事项 心肌梗死诊断 肌红蛋白 急性冠脉综合征 病理 有机化学 化学 精神科
作者
Angela L. Straface,John H Myers,Howard J. Kirchick,Kenneth E. Blick
出处
期刊:American Journal of Clinical Pathology [Oxford University Press]
卷期号:129 (5): 788-795 被引量:50
标识
DOI:10.1309/9ggnmurljwjd88w3
摘要

We compared a rapid, point-of-care multimarker protocol with a single and serial troponin I (TnI)-only protocol in 5,244 patients admitted to the emergency department with chest pain. The diagnosis of acute myocardial infarction (AMI) was based on a doubling myoglobin level accompanied by at least a 50% increase in the creatine kinase (CK)-MB level with no detectable TnI; a doubling of myoglobin level together with any detectable TnI; or a TnI level of 0.4 ng/mL (0.4 μg/L) or more, irrespective of myoglobin or CK-MB results. By using these new criteria, 145 of 148 cases were positive for AMI (positive predictive value [PPV], 92.4%) and 3 were negative, which were also negative by the core laboratory TnI assay. Twelve confirmed non-AMI cases were positive by the new protocol, with 10 of 12 confirmed by the core laboratory as positive for TnI. The negative predictive value (NPV) was 99.9%; the overall diagnostic accuracy was 99.7%. The TnI-only protocol had a sensitivity of 68.2% with an NPV of 99.1%. With lower TnI-only cutoffs, 4 patients had false-negative results, and a PPV of 36.4% was observed. Our rapid multimarker protocol seems superior to a TnI-only approach for rapidly triaging patients with chest pain or AMI.
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