Troponin T and myoglobin in acute coronary syndromes for diagnosis, risk stratification and ruling out of myocardial infarction - Results of the North-Wurttemberg Infarction Study (NOWIS)

Aims: The multi-center North-Wurttemberg Infarction Study (NOWIS) aimed at prospectively evaluating troponin T and myoglobin in patients with acute co ronary syndrome using a predefined tlhree-step sampling algorithm, Methods: In 370 consecutive patients with acute coronary syndrome (median 6 4.3 years) troponin T (cut-off 0.1 ng/ml) and myoglobin (cut-off 80 ng/ml) were determined at admission, 4 h later and 24 h later. Results: Acute myocardial infarction within the first 24 h was present in 1 52 patients (41,1%), Of the 218 patients without acute infarction, 27 (:12, 4%) developed a severe cardiovascular in-hospital event (myocardial infarct ion or cardiac death) From day 2 to discharge. In total, from admission to discharge, myocardial infarction occurred in 179 of the 370 patients (48,4% ), (1) Diagnosis of acute infarction: Sensitivity for assessing acute infarcti on at admission rsp, 4 h later (cumulative values) was 64.4% rsp, 91.4% for myglobin and 48.0% rsp, 85,5% for troponin T, (2) Short-term risk stratification: Of the 44 troponin T positive patients 4 h after admission without acute infarction, 20 patients developed a sever e cardiovascular in-hospital event from Bay 2 to discharge (sensitivity 74, 1%), and 19 patients underwent revascularization procedures (14 PTCA, 5 CAB G), (3) Rule out infarction: In patients with negative test results 4 h rsp, 24 h after admission, the percentage of myocardial infarction (definite diagn osis at discharge) was 14.8% rsp, 5.1% for troponin T and 14.4% rsp. 13,9% for myoglobin. Conclusion: The used three-step sampling algorithm seems to be a good stand ard for daily clinical routine with respect to (1) early diagnosing acute m yocardial infarction by myoglobin and troponin T, (2) identifying acute cor onary syndrome patients at risk for severe in-hospital events within the fi rst 4 h by troponin T, and (3) exclusion of myocardial infarction within th e first 24 h by troponin T.