title: Early diagnosis and exclusion of acute myocardial infarction using biochemical monitoring. The BIOMACS Study Group. Biochemicals Markers of Acute Coronary Syndromes.
abstract: BACKGROUND
  The aim was to evaluate whether frequent analysis of creatine kinase MB (CK-MB), myoglobin and troponin T alone or in combination could either confirm or exclude acute myocardial infraction (AMI) within the first few hours after patients were admitted to hospital with chest pain and a non-diagnostic ECG.
  
  
  METHODS
  One hundred and forty-two patients with chest pain (< or = 12 h) and a non-diagnostic ECG were included in the study. Blood samples were obtained every 30 min during the first 3 h and thereafter at longer intervals. Different discriminatory levels and combinations of markers were tested for their ability to detect (n = 59) or exclude (n = 83) AMI during the first 6 h after admission.
  
  
  RESULTS
  No single marker adequately combined high early sensitivity and specificity. However, a combination of myoglobin and CK-MB analyses had a sensitivity at entry of 59%, which increased by 5-10% every 30 min and reached 92% after 2 h and 98% after 6 h with a specificity of 93%. A combination of myoglobin and troponin T analyses showed identical sensitivity but a slightly inferior specificity. In the patients with no AMI it was possible to exclude AMI in 64% within 3 h by using myoglobin and within 6 h in approximately 70% by using CK-MB or troponin T.
  
  
  CONCLUSIONS
  Monitoring of a combination of myoglobin and CK-MB or troponin T will allow confirmation or exclusion of AMI within 3-6 h in almost all patients. This method will have a large impact on the handling of patients with suspected AMI without a diagnostic ECG.
authors.affiliation: Department of Cardiology, University of Uppsala, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Lindahl
authors.forename: P
authors.initials: P
authors.lastname: Venge
authors.forename: L
authors.initials: L
authors.lastname: Wallentin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D009211:Myoglobin / Q000097:blood*; D012016:Reference Values; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D014336:Troponin; D003402:Creatine Kinase