非典型ST段抬高伴高敏肌钙蛋白T正常的胸痛患者纳入与排除急性心肌梗死的方法

The study of ruling-out or ruling-in for acute myocardial infarction in chest pain patients with normal hscTnT and atypical ST elevation

目的建立心电图非典型ST段抬高伴高敏肌钙蛋白T(hs-cTnT)正常的胸痛患者纳入与排除急性心肌梗死(AMI)的方法。方法纳入就诊于四川大学华西医院胸痛中心可疑AMI、心电图非典型ST段抬高、初次hs-cTnT≤14 ng/L的患者,收集患者基本信息和心电图(ECG)、hs-cTnT值等临床资料,评估胸痛患者纳入与排除AMI的方法,建立流程。结果对心电图非典型ST段抬高、初次hs-cTnT≤14 ng/L的胸痛患者,动态观察0/3 h排除AMI绝对变化和相对变化的阈值为60 ng/L和45%,阴性预测值(NPV)均能达到100%,灵敏度分别为88.37%和95.35%;动态观察3 h纳入AMI绝对变化和相对变化的阈值为112ng/L和120%,阳性预测值(PPV)可达到80%,特异度分别为86.67%和83.5%。结论对心电图非典型ST段抬高、初次hs-cTnT正常的胸痛患者使用0/3 h动态观察策略纳入与排除AMI结果可靠,阳性预测值与阴性预测值分别为80%和100%。

Objective The aim of this study is to evaluate the rule-out and rule-in strategy for acute myo-cardial infarction(AMI)in chest pain patients with normal high-sensitivity troponin T(hs-cTnT)and atypical ST elevation.Methods Adults presenting to chest pain center from January 2016 to January 2017 with chief com-plain of chest pain in West China hospital of Sichuan university were enrolled.Clinical data including ECG and hs-cTnT concentration were obtained and evaluated for the diagnostic value of strategies.Finally,the rule-out and rule-in strategy was established for AMI in chest pain patients.Results 153 patients were enrolled,and 0/3 h dynamic was observed for ruling out AMI among patients whose first hs-cTnT levels were less than 14 ng/L.The threshold value of absolute and relative change were 60 ng/L and 45%;negative predictive value(NPV)were 100%;sensi-tivity were 88.37%and 95.35%.For ruling-in AMI,the threshold value of absolute and relative change were 112 ng/L and 120%;positive predictive value(PPV)were 80%;specificity were 86.67%and 83.5%.Conclusion For patients who were with the first hs-cTnT level less than 14 ng/L and atypical ST elevation,the 0/3 h rule-in and rule-out algorithm strategy have reliable diagnostic value for AMI,and the PPV and NPV was high enough to apply.