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

• 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
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/S0196-0644(03)00411-6

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.