BIOCHEMICAL MARKERS OF ACUTE MYOCARDIAL-INFARCTION - STRATEGIES FOR IMPROVING THEIR CLINICAL USEFULNESS

We investigated the early diagnostic utility, including incremental va lue, of the serum cardiac markers creatine kinase (CK), CK-MB (mass an d activity measurements), cardiac troponin T, and myoglobin in the dia gnosis of acute myocardial infarction (AMI) in patients presenting to a major teaching hospital with chest pain and non-diagnostic electroca rdiographs (ECG). The reference diagnosis of acute myocardial infarcti on was made by a single, independent cardiologist using World Health O rganization criteria. CK and CK-MB mass were the only significant pred ictors of AMI at presentation to the Emergency Department. Logistic re gression analysis revealed that CK did not significantly predict (P=0. 23) myocardial infarction once CK-MB mass was in the model. Using test results on follow up, in addition to presentation CK-MB mass, change in CK-MB mass was the only other significant independent predictor of AMI. Likelihood ratios for various levels of the significant markers i n the logistic regression are given. In conclusion, CK-MB mass measure ment was the only useful serum cardiac marker for the diagnosis of AMI in patients presenting with chest pain with non-diagnostic ECGs.