实用医学杂志2024，Vol.40Issue(16)：2326-2332,7.DOI:10.3969/j.issn.1006-5725.2024.16.020
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
Diagnostic value of POCT-cTnT for acute myocardial infarction based on symptom onset time
摘要
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 charac-teristics 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 differ-ence 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.关键词
床旁检测/心肌肌钙蛋白T/急性心肌梗死/胸痛Key words
point-of-care testing/cardiac troponin T/acute myocardial infarction/chest pain分类
临床医学引用本文复制引用
陈国军,周天恩,刘宏锋,彭丽娜,姜骏,谢春明..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[J].实用医学杂志,2024,40(16):2326-2332,7.基金项目
广东省医学科学技术研究基金项目(编号:B2021263) （编号:B2021263）
