目的:使用现场护理(POC)高敏心肌肌钙蛋白I(hs-cTnI)测定评估疑似急性心肌梗死(AMI)患者的策略可能会加快急诊护理。针对疑似AMI的急诊患者,得出并验证了2小时POChs-cTnI策略。
方法:在两个国际,多中心,prospective,对疑似AMI的成人急诊患者(1486个衍生队列和1796个验证队列)的观察性研究,在入院时和2小时后测量hs-cTnI(SiemensAtellica®VTLi)。经裁定的最终诊断在临床使用中使用了hs-cTn测定。推导并验证了风险分层算法。主要诊断结果为AMI指数(1型和2型)。主要安全性结果是30天主要不良心脏事件,包括AMI和心脏死亡。
结果:总体而言,推导和验证队列中的81名(5.5%)和88名(4.9%)患者,分别,有AMI。2小时算法将66.1%定义为低风险,敏感性为98.8%[95%置信区间(CI)89.3%-99.9%],阴性预测值为99.9(95%CI99.2%-100%)。在验证队列中,53.3%的患者为低风险,敏感性为98.9%(95%CI92.4%-99.8%),指标AMI的阴性预测值为99.9%(95%CI99.3%-100%)。高风险指标确定了5.4%的患者,其指数AMI的特异性为98.5%(95%CI96.6%-99.4%),阳性预测值为74.5%(95%CI62.7%-83.6%)。
结论:使用POChs-cTnI浓度的2小时算法可以对疑似AMI患者进行安全有效的风险评估。POC测试的短周转时间可能支持在大部分疑似AMI的急诊患者的管理中的显着效率。
OBJECTIVE: Strategies to assess patients with suspected acute myocardial infarction (AMI) using a point-of-care (POC) high-sensitivity cardiac troponin I (hs-cTnI) assay may expedite emergency care. A 2-h POC hs-cTnI strategy for emergency patients with suspected AMI was derived and validated.
METHODS: In two international, multi-centre, prospective, observational studies of adult emergency patients (1486 derivation cohort and 1796 validation cohort) with suspected AMI, hs-cTnI (Siemens Atellica® VTLi) was measured at admission and 2 h later. Adjudicated final diagnoses utilized the hs-cTn assay in clinical use. A risk stratification algorithm was derived and validated. The primary diagnostic outcome was index AMI (Types 1 and 2). The primary safety outcome was 30-day major adverse cardiac events incorporating AMI and cardiac death.
RESULTS: Overall, 81 (5.5%) and 88 (4.9%) patients in the derivation and validation cohorts, respectively, had AMI. The 2-h algorithm defined 66.1% as low risk with a sensitivity of 98.8% [95% confidence interval (CI) 89.3%-99.9%] and a negative predictive value of 99.9 (95% CI 99.2%-100%) for index AMI in the derivation cohort. In the validation cohort, 53.3% were low risk with a sensitivity of 98.9% (95% CI 92.4%-99.8%) and a negative predictive value of 99.9% (95% CI 99.3%-100%) for index AMI. The high-risk metrics identified 5.4% of patients with a specificity of 98.5% (95% CI 96.6%-99.4%) and a positive predictive value of 74.5% (95% CI 62.7%-83.6%) for index AMI.
CONCLUSIONS: A 2-h algorithm using a POC hs-cTnI concentration enables safe and efficient risk assessment of patients with suspected AMI. The short turnaround time of POC testing may support significant efficiencies in the management of the large proportion of emergency patients with suspected AMI.