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 MBmass

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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