- 作者：Martin Schø ; nemann-Lund ; MD&lowast ; ; ; Mikkel Malby Schoos ; MD ; PhD&dagger ; ; Kasper Iversen ; MD ; DMSc&Dagger ; ; Steen I. Hansen ; MSc Engineering§ ; ; Jø ; rgen Thode ; MD ; DMSc§ ; ; Peter Clemmensen ; MD ; DMSc ; FESC ; FSCAI‖ ; Rolf Steffensen ; MD ; MPA¶ ;
- 关键词：acute coronary syndrome ; sensitivity ; specificity ; triage ; troponin ; undetectable levels ; limit of detection
- 刊名：Journal of Emergency Medicine
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：49
- 期：6
- 页码：833-842
- 全文大小：719 K
Objectives
To evaluate this new tool, which uses diagnostic levels of high-sensitivity troponin T (hs-TnT; > 14 ng/L) in a slightly modified version and compare this to a recently proposed approach using undetectable levels of hs-TnT to rule out patients.
Methods
There were 534 consecutive patients with suspected ACS included. Protocol 1: symptom duration, hs-TnT at 0 and 6–9 h, Global Registry of Acute Coronary Events (GRACE) score, and symptom status at 6–9 h. Protocol 2: a single blood sample of hs-TnT. The primary endpoint was a discharge diagnosis of ACS by blinded adjudication. Secondary endpoints were ACS re-admission < 30 days and 1-year mortality.
Results
Protocol 1 classified 434/534 (81%) patients, with 27.9% being ruled out. All myocardial infarctions were correctly ruled in, but 15 cases of unstable angina were missed, resulting in a sensitivity and negative predictive value of 87.3% (79.6–92.5%) and 87.6% (80.4–92.9%), respectively. Protocol 2 ruled out 17.5% of the population, yielding a sensitivity and negative predictive value of 94.1% (88.2–97.6%) and 90.8% (81.9–96.2%), respectively. Both protocols correctly ruled in 2/3 patients with ACS re-admission < 30 days and 55/56 1-year fatalities.
Conclusion
The present study confirms the diagnostic value of a modified version of the ESC rule-out protocol (Protocol 1) in N-STE ACS patients, but also suggests that a simpler protocol using undetectable levels of hs-TnT (Protocol 2) could provide a similar or even superior sensitivity.