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Diagnostic value of serial measurement of cardiac markers in patients with chest pain: limited value of adding myoglobin to troponin I for exclusion of myocardial infarction
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Kardiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Kardiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Kardiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Kardiologi)
2004 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 148, no 4, 574-581 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Despite improved laboratory assays for cardiac markers and a revised standard for definition of myocardial infarction (AMI), early detection of coronary ischemia in unselected patients with chest pain remains a difficult challenge.

METHODS:

Rapid measurements of troponin I (TnI), creatine kinase MB (CK-MB), and myoglobin were performed in 197 consecutive patients with chest pain and a nondiagnostic electrocardiogram for AMI. The early diagnostic performances of these markers and different multimarker strategies were evaluated and compared. Diagnosis of AMI was based on European Society of Cardiology/American College of Cardiology criteria.

RESULTS:

At a given specificity of 95%, TnI yielded the highest sensitivity of all markers at all time points. A TnI cutoff corresponding to the 10% coefficient of variation (0.1 microg/L) demonstrated a cumulative sensitivity of 93% with a corresponding specificity of 81% at 2 hours. The sensitivity was considerably higher compared to CK-MB and myoglobin, even considering patients with a short delay until admission. Using the 99th percentile of TnI results as a cutoff (0.07 microg/L) produced a cumulative sensitivity of 98% at 2 hours, but its usefulness was limited due to low specificities. Multimarker strategies including TnI and/or myoglobin did not provide a superior overall diagnostic performance compared to TnI using the 0.1 microg/L cutoff.

CONCLUSION:

A TnI cutoff corresponding to the 10% coefficient of variation was most appropriate for early diagnosis of AMI. A lower TnI cutoff may be useful for very early exclusion of AMI. CK-MB and in particular myoglobin did not offer additional diagnostic value.

Place, publisher, year, edition, pages
2004. Vol. 148, no 4, 574-581 p.
Keyword [en]
Aged, Angina; Unstable/blood/*diagnosis, Biological Markers/blood, Chest Pain/*blood, Creatine Kinase/*blood, Diagnosis; Differential, Female, Humans, Isoenzymes/*blood, Male, Middle Aged, Myocardial Infarction/blood/*diagnosis, Myoglobin/*blood, Research Support; Non-U.S. Gov't, Sensitivity and Specificity, Troponin I/*blood
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Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-71670DOI: 10.1016/j.ahj.2004.04.030PubMedID: 15459585OAI: oai:DiVA.org:uu-71670DiVA: diva2:99581
Available from: 2005-08-23 Created: 2005-08-23 Last updated: 2017-11-21Bibliographically approved

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Eggers, KaiOldgren, JonasLindahl, Bertil

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