Utility of cardiac troponin I, creatine kinase-MBmass, myosin light chain 1, and myoglobin in the early in-hospital triage of "high risk" patients with chest pain
Gs. Hillis et al., Utility of cardiac troponin I, creatine kinase-MBmass, myosin light chain 1, and myoglobin in the early in-hospital triage of "high risk" patients with chest pain, HEART, 82(5), 1999, pp. 614-620
Citations number
36
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective-To evaluate the use of cardiac troponin I (cTnI), creatine kinase
-MBmass (CK-MBmass), myosin light chain 1 (MLC 1), and myoglobin in identif
ying "high risk" patients with chest pain who will experience serious cardi
ac events (SCEs) in hospital.
Design-Prospective study.
Setting-University affiliated medical centre in Philadelphia, USA.
Patients-208 patients with chest pain, at > 7% risk of acute myocardial inf
arction (MI), but without new ST segment elevation on their presenting EGG.
Interventions-cTnI, CK-MBmass, MLC 1, and myoglobin concentrations were obt
ained on admission (0 hour) and at 4, 8, 16, and 24 hours.
Main outcome measures-The sensitivity, specificity, positive and negative p
redictive value, and pre- and post-test probabilities of patients suffering
an SCE in hospital were determined. SCEs included cardiac death, acute MI,
cardiac arrest, Life threatening cardiac arrhythmia, cardiogenic shock, an
d urgent coronary revascularisation.
Results-Admission concentrations of all markers were poor predictors of SCE
s in hospital but improved substantially at subsequent timepoints. cTnI and
CK-MBmass were consistently the most useful prognostic indicators. If both
were negative at 0, 4, and 8 hours, then 99% (95% confidence interval 96%
to 100%) of patients remained free from SCEs. The only SCEs not thus predic
ted were revascularisation procedures and associated complications. Additio
nal tests after 8 hours, or the inclusion of additional markers, did not im
prove predictive accuracy further.
Conclusions-Patients with high risk clinical features on admission who have
negative cTnI and CK-MBmass concentrations at 0, 4, and 8 hours later have
a favourable in-hospital prognosis and could be considered for early triag
e out of coronary care units.