The prognostic significance of serial myoglobin, troponin I, and creatine kinase–MB measurements in patients evaluated in the emergency department for acute coronary syndrome

We sought to determine the value of serial measurements of myoglobin, cardiac troponin I (cTnI), and creatine kinase–MB (CK-MB) to predict 30-day adverse events in patients evaluated in the emergency department (ED) for possible acute coronary syndrome. Serum myoglobin, cTnI, and CK-MB levels were m...

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Bibliographic Details
Published in:Annals of emergency medicine 2003-09, Vol.42 (3), p.343-350
Main Authors: McCord, James, Nowak, Richard M., Hudson, Michael P., McCullough, Peter A., Tomlanovich, Michael C., Jacobsen, Gordon, Tokarski, Glenn, Khoury, Nabil, Weaver, W.Douglas
Format: Article
Language:English
Subjects:
Acute Disease
Aged
Biomarkers - blood
Coronary Disease - blood
Coronary Disease - mortality
Creatine Kinase - blood
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Myoglobin - blood
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Time Factors
Troponin I - blood
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Summary:We sought to determine the value of serial measurements of myoglobin, cardiac troponin I (cTnI), and creatine kinase–MB (CK-MB) to predict 30-day adverse events in patients evaluated in the emergency department (ED) for possible acute coronary syndrome. Serum myoglobin, cTnI, and CK-MB levels were measured at presentation, 90 minutes, 3 hours, and 9 hours in patients evaluated in the ED for possible acute coronary syndrome. In 764 consecutive patients, the ability of each individual marker and combination of markers to predict a 30-day adverse event (death or myocardial infarction) over time was calculated. There were 109 (14%) patients with an adverse event at 30 days (84 myocardial infarctions and 43 deaths). The sensitivities of initial measurements of myoglobin, cTnI, and CK-MB for identifying adverse events were 60%, 47%, and 52%, respectively. The combined sensitivity of myoglobin and cTnI measurements during a 9-hour period was 94%; specificity was 50%. Measurement of CK-MB did not improve sensitivity. The measurement of both myoglobin and cTnI during a 9-hour period was the most predictive of subsequent adverse events in patients evaluated in the ED for possible acute coronary syndrome.
ISSN:0196-0644
1097-6760
DOI:10.1016/S0196-0644(03)00411-6