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心筋梗塞の再定義:コミュニティにおける将来の評価
Véronique L Roger1, Jill M Killian, Susan A Weston
1Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA. roger.veronique@mayo.edu
Circulation
|August 16, 2006
まとめ
トロポニンを用いた心筋梗塞 (MI) の新しい定義は,クレアチンキナーゼと比較して検出率を74パーセント大幅に高めています. しかし,臨床的受け入れは不完全であり,病気の負担を潜在的に過小評価しています.
科学分野:
- 心臓病学 心臓病学
- バイオマーカー分析 バイオマーカー分析
- クリニカル診断士
背景:
- 2000年,欧州心臓学会/アメリカ心臓学会は,心筋梗塞 (MI) の基準を再定義した.
- 新しい定義はトロポニン濃度を含み,クレアチンキナーゼ (CK) を置き換えている.
- MIの検出率と臨床的受け入れに対する影響は,以前は知られていませんでした.
研究 の 目的:
- トロポニンベースの基準を使用してMI検出の増加を定量化します.
- 新しいMIの定義の臨床的受け入れと影響を評価する.
- トロポニンを用いたMIの識別を,従来のCK法と比較する.
主な方法:
- 2002年11月から2005年3月までの間にトロポニンT値が上昇した患者 (>または=0.03ng/mL) の予測分類.
- 標準化されたMI基準が適用され,心臓の痛み,心電図の変化 (ミネソタコード),同時トロポニン,CK,CK-MBの測定が行われました.
- 動的トロポニン変化によって特定されたMI症例の比較とCKおよびCK-MBレベル.
主要な成果:
- トロポニンベースの基準では538件のMIsが特定され,CK (327件のMIs) とCK-MB (427件のMIs) よりも74%増加した.
- トロポニン基準のみで特定された症例では,ECGでのSTセグメントの上昇が少なく,生存率が向上しました.
- トロポニンのみの症例では,臨床診断のMIは,以前の基準 (74%) と比較して,トロポニンのみの症例では低かった (42%).
結論:
- 新しいMI基準の将来の適用は,診断された症例の有意な増加につながり,患者の症例ミックスが変化します.
- トロポニンベースの基準の不完全な臨床的受け入れは,MIの罹患率の過小評価につながる可能性があります.
- MI率を評価する将来の研究では,更新された診断定義の影響を考慮する必要があります.
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