Journal Article

Very early diagnosis and risk stratification of patients admitted with suspected acute myocardial infarction by the combined evaluation of a single serum value of cardiac troponin-T, myoglobin, and creatine kinase MB<sub>mass</sub>

B. Jurlander, P. Clemmensen, G. S. Wagner and P. Grande

in European Heart Journal

Published on behalf of European Society of Cardiology

Volume 21, issue 5, pages 382-389
Published in print March 2000 | ISSN: 0195-668x
Published online March 2000 | e-ISSN: 1522-9645 | DOI: https://dx.doi.org/10.1053/euhj.1999.1760
Very early diagnosis and risk stratification of patients admitted with suspected acute myocardial infarction by the combined evaluation of a single serum value of cardiac troponin-T, myoglobin, and creatine kinase MBmass

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Aims The diagnostic and prognostic capacity of biochemical markers of acute myocardial infarction in the emergency department were evaluated in consecutive patients (n=155) with suspected acute myocardial infarction.

Methods and Results Serum myoglobin ≥110μg.l−1and creatine kinase MBmass≥5μg.l−1had a high accuracy (0·77–0·85) (ns) for acute myocardial infarction diagnosis in patients presenting >2h after symptom onset. Troponin-T (≥0·10μg.l−1) had a lower accuracy (0·53–0·70) for acute myocardial infarction diagnosis, but was the most important 1-year prognostic marker (cardiac death or non-fatal acute myocardial infarction). In patients without ST elevation, combined analysis of two biochemical tests would accurately identify an additional 20% of acute myocardial infarction patients (predictive value of a positive test=0·82) and also identify those without acute myocardial infarction (predictive value of a negative test=0·80). One-year event-free survival was excellent (96%) for patients with two negative biochemical tests, intermediate (74%) for those with discordant tests, and only 53% for patients with two positive biochemical tests.

Conclusion Analysis of biochemical tests in the emergency department prior to hospital admission could accurately identify approximately 20% additional acute myocardial infarction patients. The prognosis of these patients is poor, and they may be a target for primary PTCA or new early initiated aggressive medical therapies.

Keywords: Myocardial infarction, diagnosis, prognosis, myoglobin, troponin-T, creatine kinase MBmass

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Subjects: Cardiovascular Medicine

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