突破性研究:預診所心肌梗塞速測技術,提高救治效率

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丹麥中部地區進行的研究顯示,急救人員進行的預診所定量心肌梗塞點測試(POC-cTnT)在心肌梗塞(AMI)患者的快速識別和預後預測方面極具潛力。該測試於2010年至2011年期間進行,共有985名疑似AMI病患接受試驗。研究發現,POC-cTnT測試不僅能夠協助識別AMI病患,而且其結果與病患死亡率有高度相關,即使最終診斷不是AMI。

在急性心肌梗塞懷疑病患中,使用定量點護護理肌鈣蛋白T測量以進行診斷和預後

Quantitative point-of-care troponin T measurement for diagnosis and prognosis in patients with a suspected acute myocardial infarction

Stengaard C, Sørensen JT, Ladefoged SA, et al. Quantitative point-of-care troponin T measurement for diagnosis and prognosis in patients with a suspected acute myocardial infarction. Am J Cardiol. 2013;112(9):1361-1366. doi:10.1016/j.amjcard.2013.06.026

https://pubmed.ncbi.nlm.nih.gov/23953697/

Abstract

Improvement of prehospital triage is essential to ensure rapid management of patients with acute myocardial infarction (AMI). This study evaluates the feasibility of prehospital quantitative point-of-care cardiac troponin T (POC-cTnT) analysis, its ability to identify patients with AMI, and its capacity to predict mortality. The study was performed in the Central Denmark Region from May 2010 to May 2011. As a supplement to electrocardiography, a prehospital POC-cTnT measurement was performed by a paramedic in patients with suspected AMI. AMI was diagnosed according to the universal definition of myocardial infarction using the ninety-ninth percentile upper reference level as diagnostic cut point. The paramedics performed POC-cTnT measurements in 985 subjects with a symptom duration of 70 minutes (95% CI, 35 to 180); of whom, 200 (20%) had an AMI. The prehospital sample was obtained 88 minutes (range, 58 to 131) before the sample made on admission to the hospital. The sensitivity for detection of patients with an AMI was 39% (95% CI, 32% to 46%) and the diagnostic accuracy of the POC-cTnT values was 0.67 (95% CI, 0.64 to 0.71). Adjusted survival analysis showed a strong significant association between elevated prehospital POC-cTnT level above the detection level of 50 ng/L and mortality in patients with a suspected AMI irrespective of whether an AMI was diagnosed. In conclusion, large-scale quantitative prehospital POC-cTnT testing by paramedics is feasible. An elevated prehospital POC-cTnT value contains diagnostic information and is highly predictive of mortality in patients with a suspected AMI.

摘要

改善急性心肌梗塞(AMI)患者的院前分流至關重要,以確保對患者進行快速處理。本研究評估了院前定量點護心肌肌鈣蛋白T(POC-cTnT)分析的可行性、其識別AMI患者的能力,以及其預測死亡率的能力。研究於2010年5月至2011年5月在丹麥中部地區進行。作為心電圖的補充,由急救人員在懷疑AMI的患者中進行院前POC-cTnT測量。根據心肌梗塞的普遍定義以及使用第九十九百分位上參考水平作為診斷切點來診斷AMI。急救人員對985名症狀持續時間為70分鐘(95% CI,35至180)的受試者進行了POC-cTnT測量;其中,200名(20%)患有AMI。院前樣本在入院樣本前88分鐘(範圍58至131分鐘)獲得。檢測AMI患者的敏感度為39%(95% CI,32%至46%),POC-cTnT值的診斷準確度為0.67(95% CI,0.64至0.71)。調整後的存活分析顯示,無論是否診斷出AMI,院前POC-cTnT水平高於50 ng/L檢測水平與懷疑AMI患者的死亡率之間存在強烈的顯著相關性。總之,由急救人員進行大規模的院前定量POC-cTnT檢測是可行的。院前POC-cTnT值的升高包含診斷信息,並且對於懷疑AMI的患者的死亡率具有很高的預測性。