Troponin-Test im Alltag – Unterschiede der Gütekriterien in der Diagnose des akuten Myokardinfarkts unter Berücksichtigung klinischer Leitsymptome: eine Querschnittsstudie

Zusammenfassung

Einleitung Die kardialen Troponine sind die bevorzugten kardialen Biomarker in der Diagnostik eines akuten Myokardinfarkts. Sie sind jedoch bei jeglichen Myokardzellschäden, egal welcher Pathophysiologie, nachweisbar. Das Ziel dieser Studie ist, zu beurteilen, wie die Gütekriterien des Troponin-Tests in der Diagnose des akuten Myokardinfarkts im Alltag sind und ob klinische Leitsymptome einen Einfluss darauf haben.

Methode Es handelt sich um eine retrospektive Querschnittsstudie, in welche alle Patienten, die sich in der Notaufnahme des Klinikums Lippe-Detmold zwischen dem 01.01.2014 und dem 31.05.2014 vorstellten und einen Troponin-Test hatten, eingeschlossen wurden. Die Diagnose akuter Myokardinfarkt bezog sich auf den Myokardinfarkt Typ I und wurde durch den diensthabenden Kardiologen gestellt. Die Patienten wurden in 4 Subgruppen entsprechend der Leitsymptome unterteilt. Die Gütekriterien des Troponin-Tests wurden berechnet.

Ergebnisse 1046 Patienten wurden eingeschlossen. Bei 15 % lag ein akuter Myokardinfarkt vor, 97 % von diesen hatten thorakale Schmerzen. Die Sensitivitäten und die negativen prädiktiven Werte lagen über 90 %. Die Spezifitäten lagen zwischen 56 % und 81 %. Die positiven prädiktiven Werte waren bescheiden und am besten bei den thorakalen Schmerzen mit 58 %.

Schlussfolgerung Bei allen klinischen Leitsymptomen hatte der Troponin-Test einen guten negativen prädiktiven Wert. Ein akuter Myokardinfarkt konnte somit mit hoher Präzision ausgeschlossen werden. Der positive prädiktive Wert war hingegen niedrig. Lediglich bei dem Leitsymptom Thoraxschmerz konnten akzeptable Werte erreicht werden.

Abstract

Introduction Cardiac troponins are the prefered cardial biomarker in the diagnosis of acute myocardial infarction. Because they are detectable by myocardial cell damage, no matter what pathophysiology, the interpretation of a positive test is difficult. The aim of this study is to assess the quality criteria of the troponin test in the diagnosis of acute myocardial infarction in everyday life and whether clinical leading symptoms have an influence on it.

Methods This is a retrospective cross-sectional study, in which all patients who presented themselves in the emergency department of the Klinikum Lippe-Detmold between 01.01.2014 and 31.05.2014, and had a Troponin-I test were included. The diagnosis “acute myocardial infarction” referred to myocardial infarction type I and was made by the cardiologist on-duty. The patients were divided into four subgroups according to the leading symptoms. The quality criteria of the Troponin-test were calculated.

Results 1046 patients were included. In 15 %, acute myocardial infarction was present, of which 97 % had thoracic pain. The sensitivities and the negative predictive values were over 90 %. The specificities ranged between 56 % and 81 %. The positive predictive values were modest and best in case of thoracic pain 58 %.

Conclusion The Troponin test had a good negative predictive value for all clinical symptoms. Thus, an acute myocardial infarction could be excluded with high precision. However, the positive predictive value was low. The only direct symptom that achieved acceptable levels was thoracic pain.

Schlüsselwörter

kardiale Troponine - akuter Myokardinfarkt - Myokardverletzung - thorakale Schmerzen - Dyspnoe

Key words

cardiac troponins - acute myocardial infarction - myocardial injury - thoracic pain - dyspnea

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