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
• 来源期刊: 世界急诊医学杂志（英文版）
• 年，卷（期）: 2022,（3）
• 所属期刊栏目: Original Articles
• 页码范围: 163-168
• 页数: 6页
• 语种: 中文
• DOI: 10.5847/wjem.j.1920-8642.2022.033

摘要

BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-cTn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(cTn)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 cTn assays:the point-of-care cTn(POC-cTn)group,the contemporary cTn(c-cTn)group,and hs-cTn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-cTn/c-cTn assays,combining CK-MB and POC-cTn/c-cTn 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-cTn did not change the sensitivity compared with hs-cTn alone(95.0％vs.95.0％,P＞0.999).In the subgroup analysis,the sensitivity of combining CK-MB and c-cTn increased with time from symptom onset＜6 h compared with c-cTn 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-cTn significantly increased compared to the single POC-cTn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CK-MB and c-cTn/hs-cTn assays did not significantly decrease compared with that of the single c-cTn/hs-cTn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-cTn or c-cTn may be valuable for the early diagnosis of AMI,especially when hs-cTn is not available.