胸痛发作时床边即时检测心肌钙蛋白T诊断急性心肌梗死的价值

doi:10.3969/j.issn.1006-5725.2024.16.020

Abstract

Abstract:

The sensitivity of cardiac troponin testing for diagnosing acute myocardial infarction （AMI） varies over time from chest pain onset. This study aimed to determine the diagnostic performance of point?of?care testing cardiac troponin T （POCT?cTnT） at different time intervals post?symptom onset to refine rapid rule?out approaches for AMI. Methods This retrospective study included 6，024 patients presenting with chest pain from January 2018 to December 2022. POCT?cTnT and central lab cTnI levels were measured on admission. Receiver operating characteristics analysis stratified by time windows assessed the accuracy of POCT?cTnT for diagnosing AMI. Results The overall AUC of POCT?cTnT for diagnosing AMI was 0.826 （95% CI：0.816 ~ 0.836）， with a sensitivity of 72.81% and a specificity of 86.26%. According to the time intervals of chest pain onset （< 3 hours， 3 ~ 6 hours， 6 ~ 12 hours， 12 ~ 24 hours， 24 ~ 72 hours， and ≥ 72 hours）， the AUC values for groups after 6 ~ 12 hours were 0.918， 0.928， 0.920 and 0.908， respectively， with no statistically significant difference （P > 0.05）， but all were higher than the groups within 6 hours （P < 0.001）. According to the time of chest pain onset， the AUC for the ≥8h group was 0.921， with a negative predictive value （NPV） of 98.1% and a negative likelihood ratio （?LR） of 0.11. Its AUC was higher than those of the ≥ 3 h， ≥ 2 h， ≥ 1 h， and overall groups （P < 0.05）， but there was no statistically significant difference compared with the groups after ≥ 4 h （P > 0.05）. Conclusions Chest pain onset time has a certain impact on the performance of a single POCT?cTnT test for diagnosing AMI. The duration from chest pain onset to hospital admission combined with POCT?cTnT test may improve the reliability in diagnosing AMI. Specifically， a single POCT?cTnT test at four hours after chest pain onset， especially eight hours after chest pain onset， can diagnose or exclude AMI.

Key words: point?of?care testing, cardiac troponin T, acute myocardial infarction, chest pain

CLC Number:

R542.2+2

Guojun CHEN,Tianen ZHOU,Hongfeng LIU,Li′na PENG,Jun JIANG,Chunming. XIE. Diagnostic value of POCT⁃cTnT for acute myocardial infarction based on symptom onset time[J]. The Journal of Practical Medicine, 2024, 40(16): 2326-2332.

Figures/Tables 7

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References 31

1	TSAO C W， ADAY A W， ALMARZOOQ Z I， et al. Heart Disease and Stroke Statistics-2023 Update： A Report From the American Heart Association［J］. Circulation， 2023，147（8）：e93-e621. doi:10.1161/cir.0000000000001137 doi: 10.1161/cir.0000000000001137
2	ZHOU M， WANG H， ZENG X， et al. Mortality， morbidity， and risk factors in China and its provinces， 1990-2017： A systematic analysis for the Global Burden of Disease Study 2017［J］. Lancet，2019，394（10204）：1145-1158. doi:10.1016/s0140-6736(19)30427-1 doi: 10.1016/s0140-6736(19)30427-1
3	IBANEZ B， JAMES S， AGEWALL S， et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation： The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology （ESC）［J］. Eur Heart J， 2018，39（2）：119-177.
4	COLLET J P， THIELE H， BARBATO E， et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation［J］. Eur Heart J，2021，42（14）：1289-1367.
5	HALLANI H， LEUNG D Y， NEWLAND E， et al. Use of a quantitative point-of-care test for the detection of serum cardiac troponin T in patients with suspected acute coronary syndromes［J］. Intern Med J，2005，35（9）：560-562. doi:10.1111/j.1445-5994.2005.00897.x doi: 10.1111/j.1445-5994.2005.00897.x
6	RAHSEPAR S， JAHROMI M S S， ABIRI S， et al. Point-of-Care Tests′ Role in Time Metrics of Urgent Inter- ventions in Emergency Department； a Systematic Review of Literature［J］. Arch Acad Emerg Med， 2022，10（1）：e82.
7	DAWSON L P， NEHME E， NEHME Z， et al. Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment［J］. JAMA Intern Med，2023，183（3）：203-211. doi:10.1001/jamainternmed.2022.6409 doi: 10.1001/jamainternmed.2022.6409
8	FLORKOWSKI C， DON-WAUCHOPE A， GIMENEZ N， et al. Point-of-care testing （POCT） and evidence-based laboratory medicine （EBLM）-does it leverage any advantage in clinical decision making？［J］. Crit Rev Clin Lab Sci， 2017，54（7-8）：471-494. doi:10.1080/10408363.2017.1399336 doi: 10.1080/10408363.2017.1399336
9	GOU Q， LIANG L， LIU D， et al. Clinical performance of 0/1 h cardiac troponin algorithm for diagnosing non-STEMI in an emergency setting［J］. Am J Emerg Med， 2023，71：139-143. doi:10.1016/j.ajem.2023.06.036 doi: 10.1016/j.ajem.2023.06.036
10	EGGERS K M， LAGERQVIST B， OLDGREN J， et al. Pathophysiologic mechanisms of persistent cardiac troponin I elevation in stabilized patients after an episode of acute coronary syndrome［J］. Am Heart J， 2008，156（3）：588-594. doi:10.1016/j.ahj.2008.04.022 doi: 10.1016/j.ahj.2008.04.022
11	KATUS H A， REMPPIS A， LOOSER S， et al. Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients［J］. J Mol Cell Cardiol，1989，21（12）：1349-1353. doi:10.1016/0022-2828(89)90680-9 doi: 10.1016/0022-2828(89)90680-9
12	TWERENBOLD R， COSTABEL J P， NESTELBERGER T， et al. Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction［J］. J Am Coll Cardiol，2019，74（4）：483-494. doi:10.1016/j.jacc.2019.05.046 doi: 10.1016/j.jacc.2019.05.046
13	TWERENBOLD R， COSTABEL J P， NESTELBERGER T， et al. Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction［J］. J Am Coll Cardiol， 2019，74（4）：483-494. doi:10.1016/j.jacc.2019.05.046 doi: 10.1016/j.jacc.2019.05.046
14	MEHTA M D， MARWAH S A， GHOSH S， et al. A Synergistic Role of Myeloperoxidase and High Sensitivity Troponin T in the Early Diagnosis of Acute Coronary Syndrome［J］. Indian J Clin Biochem， 2016，31（1）：75-80. doi:10.1007/s12291-015-0490-4 doi: 10.1007/s12291-015-0490-4
15	SAWICKI M， SYPNIEWSKA G， KOZINSKI M， et al. Diagnostic efficacy of myeloperoxidase for the detection of acute coronary syndromes［J］. Eur J Clin Invest， 2011，41（6）：667-671. doi:10.1111/j.1365-2362.2010.02457.x doi: 10.1111/j.1365-2362.2010.02457.x
16	GOLDMANN B U， RUDOLPH V， RUDOLPH T K， et al. Neutrophil activation precedes myocardial injury in patients with acute myocardial infarction［J］. Free Radic Biol Med， 2009，47（1）：79-83. doi:10.1016/j.freeradbiomed.2009.04.004 doi: 10.1016/j.freeradbiomed.2009.04.004
17	BALDUS S， HEESCHEN C， MEINERTZ T， et al. Myeloperoxidase serum levels predict risk in patients with acute coronary syndromes［J］. Circulation， 2003，108（12）：1440-1445. doi:10.1161/01.cir.0000090690.67322.51 doi: 10.1161/01.cir.0000090690.67322.51
18	KIM K S， LEE H J， KIM K， et al. Heart-type fatty acid binding protein as an adjunct to cardiac troponin-I for the diagnosis of myocardial infarction［J］. J Korean Med Sci， 2011，26（1）：47-52. doi:10.3346/jkms.2011.26.1.47 doi: 10.3346/jkms.2011.26.1.47
19	INOUE K， SUWA S， OHTA H， et al. Heart fatty acid-binding protein offers similar diagnostic performance to high-sensitivity troponin T in emergency room patients presenting with chest pain［J］. Circ J， 2011，75（12）：2813-2820. doi:10.1253/circj.cj-11-0598 doi: 10.1253/circj.cj-11-0598
20	KACPRZAK M， ZIELINSKA M. Prognostic value of myeloperoxidase concentration in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention［J］. Int J Cardiol， 2016，223：452-457. doi:10.1016/j.ijcard.2016.07.258 doi: 10.1016/j.ijcard.2016.07.258
21	LIPPI G， MATTIUZZI C， CERVELLIN G. Critical review and meta-analysis on the combination of heart-type fatty acid binding protein （H-FABP） and troponin for early diagnosis of acute myocardial infarction［J］. Clin Biochem， 2013，46（1-2）：26-30. doi:10.1016/j.clinbiochem.2012.10.016 doi: 10.1016/j.clinbiochem.2012.10.016
22	THYGESEN K， ALPERT J S， JAFFE A S， et al. Third universal definition of myocardial infarction［J］. J Am Coll Cardiol， 2012，60（16）：1581-1598. doi:10.1161/cir.0b013e31826e1058 doi: 10.1161/cir.0b013e31826e1058
23	THYGESEN K， ALPERT J S， JAFFE A S， et al. Fourth Universal Definition of Myocardial Infarction （2018）［J］. Circulation， 2018，138（20）：e618-e651. doi:10.1161/cir.0000000000000617 doi: 10.1161/cir.0000000000000617
24	ROFFI M， PATRONO C， COLLET J P， et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation： Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology （ESC）［J］. Eur Heart J， 2016，37（3）：267-315.
25	郭英，罗薇，丁霏，等. 高敏肌钙蛋白T正常的胸痛患者早期排除急性心肌梗死的最佳策略［J］. 实用医学杂志，2018，34（1）：63-66.
26	郭英，罗薇，丁霏，等. 非典型ST段抬高伴高敏肌钙蛋白T正常的胸痛患者纳入与排除急性心肌梗死的方法［J］. 实用医学杂志，2018，34（20）：3465-3468.
27	李小玲，罗薇，郭英，等. 初次高敏肌钙蛋白T升高的胸痛患者纳入与排除急性心肌梗死的最佳策略［J］. 实用医学杂志，2019，35（6）：920-923.
28	BRICHKO L， SCHNEIDER H G， CHAN W， et al. Rapid and safe discharge from the emergency department： A single troponin to exclude acute myocardial infarction［J］. Emerg Med Australas， 2018，30（4）：486-493. doi:10.1111/1742-6723.12919 doi: 10.1111/1742-6723.12919
29	TWERENBOLD R， COSTABEL J P， NESTELBERGER T， et al. Outcome of Applying the ESC 0/1-hour Algorithm in Patients With Suspected Myocardial Infarction［J］. J Am Coll Cardiol， 2019，74（4）：483-494. doi:10.1016/j.jacc.2019.05.046 doi: 10.1016/j.jacc.2019.05.046
30	FLORKOWSKI C， DON-WAUCHOPE A， GIMENEZ N， et al. Point-of-care testing （POCT） and evidence-based laboratory medicine （EBLM）-does it leverage any advantage in clinical decision making？［J］. Crit Rev Clin Lab Sci， 2017，54（7-8）：471-494. doi:10.1080/10408363.2017.1399336 doi: 10.1080/10408363.2017.1399336
31	PICKERING J W， YOUNG J M， GEORGE P M， et al. Validity of a Novel Point-of-Care Troponin Assay for Single-Test Rule-Out of Acute Myocardial Infarction［J］. JAMA Cardiol， 2018，3（11）：1108-1112. doi:10.1001/jamacardio.2018.3368 doi: 10.1001/jamacardio.2018.3368

变量	总体（n = 6 024）	Non?AMI（n = 5 079）	AMI（n = 945）	统计量	P值
胸痛发作时间（x ± s，h）	64.9 ± 241.6	68.4 ± 256.8	46.2 ± 130.8	6.783	0.009
年龄（x ± s，岁）	59.3 ±16.0	58.8 ±16.4	62.4 ±12.9	41.805	< 0.001
性别［例（%）］				139.597	< 0.001
男性	3 842（63.8）	3 079（60.6）	763（80.7）
女性	2 182（36.2）	2 000（39.4）	182（19.3）
POCT?cTnT（x ± s，ng/L）	144.6 ± 351.5	68.4± 164.5	554.2 ± 665.8	2 037.771	< 0.001
cTnI（x ± s，ng/mL）	0.5 ± 2.2	0.1 ±1.1	2.3 ± 4.4	970.714	< 0.001
CK（x ± s，IU/L）	202.3 ± 670.5	148.2 ± 636.3	492.7 ±768.6	217.922	< 0.001
CK.MB（x ± s，IU/L）	19.3 ± 42.3	21.5 ± 47.6	15.3 ± 30.6	711.503	< 0.001
MYO（x ± s，ng/mL）	59.6 ± 140.2	35.7 ± 83.2	188.3 ± 261.9	1 118.480	< 0.001
LDH（x ± s，IU/L）	216.9 ± 267.1	198.1 ±193.1	317.9 ± 492.4	164.390	0.539

胸痛发作至就诊时间（纳入人数）	参数							Z检验
胸痛发作至就诊时间（纳入人数）	AUC	敏感度	特异度	PPV	NPV	+LR	-LR	Z值	P值
总体（n = 6 024）	0.825	72.81	87.58	51.8	94.6	5.86	0.31	8.476	< 0.000 1^*
≥ 1 h （n = 5 659）	0.844	76.51	87.33	52.0	95.4	6.04	0.27	6.853	< 0.000 1^*
≥ 2 h （n = 5 027）	0.875	82.17	87.04	52.5	96.6	6.34	0.20	4.136	< 0.000 1^*
≥ 3 h （n = 4 477）	0.894	85.50	86.76	52.8	97.2	6.46	0.17	2.536	0.011^*
≥ 4 h （n = 4 035）	0.907	87.92	86.51	53.0	97.6	6.52	0.14	1.369	0.171
≥ 5 h （n = 3 730）	0.911	88.46	86.34	52.6	97.8	6.47	0.13	0.901	0.367
≥ 6 h （n = 3 510）	0.918	89.59	86.47	52.9	98.0	6.62	0.12	0.362	0.717
≥ 7 h （n = 3 309）	0.921	90.11	86.41	52.6	98.1	6.63	0.11	0.000	1.000
≥ 8 h （n = 3 188）	0.921	90.20	86.26	52.5	98.1	6.56	0.11
≥ 12 h （n = 2 780）	0.918	89.69	86.37	51.6	98.1	6.58	0.12	0.253	0.800
≥ 24 h （n = 2 205）	0.915	89.15	86.49	50.5	98.1	6.60	0.13	0.539	0.590
≥ 48 h （n = 1 578）	0.919	89.67	86.96	51.8	98.2	6.88	0.12	0.141	0.888
≥ 72 h （n = 1 135）	0.908	87.76	86.34	48.9	97.9	6.42	0.14	0.754	0.451

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Diagnostic value of POCT⁃cTnT for acute myocardial infarction based on symptom onset time

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心肌标志物	胸痛发作至就诊时间
	< 3 h		3 ~ 6 h		6 ~ 12 h		12 ~ 24 h		24 ~ 72 h		≥ 72 h
	AUC	P值^*	AUC	P值^*	AUC	P值^*	AUC	P值	AUC	P值^*	AUC	P值^*
POCT?cTnT	0.676	< 0.001	0.815	< 0.001	0.918	> 0.05	0.928	Ref.	0.920	> 0.05	0.908	> 0.05
cTnI	0.743	< 0.001	0.872	< 0.001	0.939	> 0.05	0.962	Ref.	0.922	0.016	0.915	0.006