Background and objective: The acute coronary syndrome (ACS)- acute infarcti
on or unstable angina pectoris - requires special monitoring and differenti
ated treatment. A prospective trial was undertaken to determine(1) clinical
characteristics of patients with chest pain; (2) value of cardiac markers
troponin T, myoglobin and CK-MB mass in differentiating cardiac and noncard
iac chest pain; (3) the proportion of patients with ACS in whom these marke
rs provided helpful additional information on admission and afterwards.
Patients and methods: 233 consecutive patients (134 men, 99 women; aged 18-
98 years), presenting in 1998 with nontraumatic chest pain at the emergency
unit of the Lippe-Detmold Hospital were prospectively enrolled in the stud
y. Levels of troponin T. myoglobin, CK-MB mass and activity and creatine ki
nase were measured on admission and after 2, 4 and 12-24 hours.
Results: ACS was ultimately diagnosed in 73 patients (31%). These were sign
ificantly older (p = 0.0015) and more often male (p = 0.046). 91% of patien
ts with ACS but only 68% of those without described the chest pain as a sen
se of pressure or stabbing (p = 0.0002). Measurement of troponin T and myog
lobin on admissionwas helpful in 39% of those with ACS, compared with 15% o
f those without. When the admission ECG was normal or nonspecific in patien
ts with ACS, troponin T was elevated in 16%, CK-MB mass in 24%. In patients
with unstable angina no single marker was associated with an increased ris
k (high rate of special supervision and intervention).
Conclusion: In the assessment of patients with acute chest pain clinical ju
dgement plays the predominant role. In the mostly elderly and male patients
with ACS (31% of the cohort) feeling of pressure or stabbing chest pain we
re most prominent (91%). Cardiac markers troponin T, CK-MB mass and myoglob
in were helpful in the differential diagnosis of chest pain, even when the
ECG was unremarkable or nonspecific. At the time of admission myoglobin was
the most significant marker for acute myocardial infarction or unstable an
gina.