Very early diagnosis and risk stratification of patients admitted with suspected acute myocardial infarction by the combined evaluation of a single serum value of cardiac troponin-T, myoglobin, and creatine kinase MBmass

Abstract

Aims The diagnostic and prognostic capacity of biochemical markers of acute myocardial infarction in the emergency department were evaluated in consecutive patients (n=155) with suspected acute myocardial infarction. Methods and Results Serum myoglobin ≥110μg.l⁻¹and creatine kinase MB_mass≥5μg.l⁻¹had a high accuracy (0·77–0·85) (ns) for acute myocardial infarction diagnosis in patients presenting >2h after symptom onset. Troponin-T (≥0·10μg.l⁻¹) had a lower accuracy (0·53–0·70) for acute myocardial infarction diagnosis, but was the most important 1-year prognostic marker (cardiac death or non-fatal acute myocardial infarction). In patients without ST elevation, combined analysis of two biochemical tests would accurately identify an additional 20% of acute myocardial infarction patients (predictive value of a positive test=0·82) and also identify those without acute myocardial infarction (predictive value of a negative test=0·80). One-year event-free survival was excellent (96%) for patients with two negative biochemical tests, intermediate (74%) for those with discordant tests, and only 53% for patients with two positive biochemical tests. Conclusion Analysis of biochemical tests in the emergency department prior to hospital admission could accurately identify approximately 20% additional acute myocardial infarction patients. The prognosis of these patients is poor, and they may be a target for primary PTCA or new early initiated aggressive medical therapies.