*For medical professionals only
height layout=”responsive” sizes=”(min-width: 320px) 320px, 100vw” src=”https://mmbiz.qpic.cn/mmbiz_png/Sv6neLWjnqrUk7lEcMZXtjuTiagLuH7DmfU00FK1JcvEfwf9tylUtViaCCjLxk4hak79cPEJic8kJGBAyjcR8BDHimgQ/640″ width=”60BDHimg>” > Are the three myocardial infarction items OUT?
Patients with acute chest pain are often accompanied by dyspnea, because of its etiology and clinical The manifestations are diverse, and the risk of fatal chest pain is high. Therefore, it is very important to establish a rapid, reasonable, and easy diagnosis and treatment procedure and route in the emergency department, optimize risk stratification and prognosis assessment, correct triage, and make treatment decisions as soon as possible.
Recently, the 2022 edition of the “Expert Consensus on the Detection of Cardiovascular Markers in Emergency Chest Pain” (hereinafter referred to as the “Consensus”) was released. Cardiovascular marker testing is recommended. Let’s take a look at what’s in it!
one
Definition and etiology
3. Elevated hs-cTn test results (>99th URL) suggest myocardial injury, but not necessarily all caused by myocardial infarction (Clinical diagnosis of AMI must be supported by evidence of clinical ischemia); it needs to be judged by combining clinical manifestations, ECG and dynamic monitoring results of hs-cTn using the same methodology.
4, hs-cTn has high myocardial specificity and detection sensitivity, and can replace traditional cTn detection in qualified medical institutions .
5. For patients with acute chest pain or dyspnea, BNP or NT-proBNP should be detected to rule out the possibility of heart failure. BNP<100ng/L, NT-proBNP<300ng/L can usually rule out the possibility of acute heart failure; while BNP<35ng/L, NT-proBNP<125ng/L can rule out chronic heart failure. possibility of decline.
Table 2: BNP and NT-proBNP cutoff values for the diagnosis of acute heart failure (ng/L)
6. When considering the diagnosis of acute heart failure, the diagnostic threshold of NT-proBNP should be adjusted according to age and renal function [50 Under age: >450ng/L; 50-75 years old: >900ng/L; over 75 years old: >1800ng/L; patients with renal insufficiency (glomerular filtration rate <60mL/min): >1200ng/ L].
7, BNP or NT-proBNP testing is helpful for risk stratification and risk stratification in patients with acute ACS and APE Prognosis assessment, and dynamic monitoring is recommended to assess the changes of the condition.
8, inhibitors of angiotensin receptor enkephalinase ( ARNI) and recombinant human BNP drugs play their role by increasing the level of BNP, and BNP cannot faithfully reflect the cardiac function; the test results of NT-proBNP are not affected by such drugs, and it is recommended to perform NT-proBNP test for patients using such drugs .
9, D-dimer based on enzyme-linked immunosorbent assay (ELISA) or homologous method (<500ng/mL, FEU ) can be directly applied to clinically assess the exclusion of patients at low and intermediate risk of APE.
10, D-ELISA based or homologous methods Dimer (<500ng/mL, FEU) can also be used for the exclusion of acute aortic dissection (AAD).
11. Assess D- The influence of physiological factors such as age should be considered in the diagnostic value of dimer detection results; for patients over 50 years old, it is recommended to use (age × 10) ng/mL as the normal reference value.
12. There is no internationally certified internal control or calibrator for D-dimer detection, and the results of different laboratories are not comparable. It is recommended to use the same method for dynamic monitoring.
13. In emergency diagnosis of acute myocardial injury, hs-cTn should be preferred in qualified medical institutions, and creatine kinase isoenzyme is not recommended ( CK-MB), myoglobin (MYO) and other biomarkers as evaluation indicators, hs-cTn can replace the traditional three items of myocardial infarction [CK-MB, MYO , Troponin (cTn)].
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Summary
This consensus is the first time to propose the combined application of three cardiovascular markers hs-cTn, BNP/NT-proBNP and D-dimer. It is suggested that other biomarkers such as CK-MB and MYO should not be used as evaluation indicators in emergency diagnosis of acute myocardial injury, and hs-cTn can replace the traditional three items of myocardial infarction.
Finally, the consensus pointed out that the combined detection of three cardiovascular markers has the advantages of timeliness, accuracy and specificity, and can effectively It can help clinicians make rapid diagnosis or differential diagnosis, and can make early risk stratification and prognosis judgment for patients.
Figure 1: Combined application of three cardiovascular markers in patients with acute chest pain or dyspnea Figure
References:
[1] Combined detection of cardiovascular markers in emergency chest pain Expert consensus.Chinese Journal of Emergency Medicine, Vol. 31, No. 4, April 2022, Chin J Emerg Med, April 2022, Vol. 31, No. 4
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