Validation of NACB and IFCC guidelines for the use of cardiac markers for early diagnosis and risk assessment in patients with acute coronary syndromes

Background: International guidelines have been established for the use of c ardiac markers in the early diagnosis and risk assessment of patients with acute coronary syndromes. Methods: A single center, prospective observation al study was conducted in a tertiary care university hospital on 200 consec utive patients with suspected acute myocardial infarction (AMI). Blood was drawn on admission and. after. 2, 4, 8, 12 and 24 h for the measurement of CK-MB/CK activity, myoglobin, CK-MB mass and troponin I. A 6-week follow-up was undertaken for the combined end point of acute coronary syndrome and d eath. Results: Myoglobin showed an early diagnostic sensitivity of 0.65 on admission, 0.90 after 2 h and 0.92 after. 4 h compared with 0.46, 0.74 and 0.88 for CK-MB/CK activity. The combination of myoglobin and cTnI increased the diagnostic value compared with myoglobin alone on admission, 2 and 4 h later. In multivariate analysis, cTnI and CK-MB/CK mass, but not myoglobin and CK-MB/CK activity, were shown to he independent predictors on the 6-we ek follow-up. Conclusions: Repetitive myoglobin measurements within 4 h of admission, combined with at least one early troponin test, was shown to be the strategy of choice in early AMI diagnosis and prognosis assessment. (C) 2001 Elsevier Science B.V. All lights reserved.