The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/contemporary cardiac troponin for the early diagnosis of acute myocardial infarction  

作　　者：Guang-mei Wang Yong Li Shuo Wu Wen Zheng Jing-jing Ma Feng Xu Jia-qi Zheng He Zhang Jia-li Wang Yu-guo Chen 

机构地区：[1]Department of Emergency Medicine,Qilu Hospital of Shandong University,Jinan 250012,China [2]Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine,Institute of Emergency and Critical Care Medicine of Shandong University,Chest Pain Center,Qilu Hospital of Shandong University,Jinan 250012,China [3]Key Laboratory of Emergency and Critical Care Medicine ofShandong Province,Key Laboratory of Cardiopulmonary-cerebral Resuscitation Research of Shandong Province,Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine,Qilu Hospital of Shandong University,Jinan 250012,China [4]Key Laboratory of Cardiovascular Remodeling and Function Research,Chinese Ministry ofEducation,Chinese Ministry of Health and Chinese Academy of Medical Sciences,The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine,Qilu Hospital of Shandong University,Jinan 250012,China

出　　处：《World Journal of Emergency Medicine》2022年第3期163-168,共6页世界急诊医学杂志（英文）

基　　金：This study was supported by grants from the National Key R&D Program of China (2017YFC0908700, 2017YFC0908703);National S&T Fundamental Resources Investigation Project (2018FY100600, 2018FY100602);Taishan Pandeng Scholar Program of Shandong Province (tspd20181220);Taishan Young Scholar Program of Shandong Province (tsqn20161065, tsqn201812129);Key R&D Program of Shandong Province (2020SFXGFY03, 2019GSF108073)

摘　　要：BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.

关 键 词：Creatine kinase-myocardial band isoenzyme Cardiac troponin Acute myocardial infarction Emergency department 

分 类 号：R542.22[医药卫生—心血管疾病]