Bedside multimarker testing for risk stratification in chest pain units - The chest pain evaluation by creatine Kinase-MB, myoglobin, and troponin I (CHECKMATE) study

Background-Earlier rapid evaluation in chest pain units may make patient ca re more efficient. A multimarker strategy (MMS) testing for several markers of myocardial necrosis with different time-to-positivity profiles also may offer clinical advantages. Methods and Results-We prospectively compared bedside quantitative multimar ker testing versus local laboratory results (LL) in 1005 patients in 6 ches t pain units. Myoglobin, creatine kinase-MB, and troponin I were measured a t 0, 3, 6, 9 to 12, and 16 to 24 hours after admission. Two MMS were define d: MMS-I tall 3 markers) and MMS-2 (creatine kinase-MB and troponin I only) . The primary assessment was to relate marker status with 30-day death or i nfarction. More patients were positive by 24 hours with MMS than with LL (M MS-1, 23.9%; MMS-2, 18.8%; LL, 8.8%; P=0.001, all comparisons), and they be came positive sooner with MR IS-I (2.5 hours, P=0.023 versus LL) versus MMS -2 (2.5 hours, P=0.026 versus LL) or LL (3.4 hours). The relation between b aseline MMS status and 30-day death or infarction was stronger (MMS-1: posi tive, 18.8% event rate versus negative, 3.0%, P=0.001; MMS-2. 21.9% versus 3.2%. P=0.001) than that for LL (13.6% versus 5.5%, P=0.038). MMS-I discrim inated 30-day death better (positive, 2.0% versus negative, 0.0%, P=0.007) than MMS-2 (positive, 1.8% versus negative, 0.2%; P=0.055) or LL (positive, 0.0%, versus negative, 0.5%; P=1.000). Conclusions-Rapid multimarker analysis identifies positive patients earlier and provides better risk stratification for mortality than a local laborat ory-based, single-marker approach.