title: Prognostic value of troponin T, myoglobin, and CK-MB mass in patients presenting with chest pain without acute myocardial infarction.
abstract: OBJECTIVE
  To assess the prognostic value of minor myocardial damage in patients presenting with chest pain without myocardial infarction.
  
  
  METHODS
  The relative risk of suffering a cardiac event in the next six months was assessed in patients with minor myocardial damage assessed by the cardiac markers CK-MB, myoglobin, and troponin T.
  
  
  METHODS
  Emergency department of a large university hospital.
  
  
  METHODS
  In 128 consecutive patients with chest pain, acute myocardial infarction (by WHO criteria) was ruled out; of these, 39 had a rise and fall of one or more markers, indicating minor myocardial damage. The presence of a documented history of coronary artery disease was assessed on admission.
  
  
  RESULTS
  24 patients had a subsequent event (cardiac death, acute myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting) in the next six months. An abnormal troponin T predicted a subsequent event while abnormal CK-MB or myoglobin did not. The relative risk for troponin T was 2.8 (95% confidence interval: 1.0 to 7.9), for myoglobin 1.0 (0.3 to 3.2), and for CK-MB 0.9 (0.2 to 3.4). A documented history of coronary artery disease predicted subsequent events with a relative risk of 3.9 (1.3 to 11.3).
  
  
  CONCLUSIONS
  Troponin T was the only marker that predicted future events, but a documented history of coronary artery disease was the best predictor in patients in whom an acute myocardial infarction had been ruled out.
authors.affiliation: Department of Cardiology, Academic Medical Centre, University of Amsterdam, Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: R W
authors.initials: RW
authors.lastname: Koster
authors.forename: J H
authors.initials: JH
authors.lastname: Schotveld
authors.forename: A
authors.initials: A
authors.lastname: Sturk
authors.forename: J P
authors.initials: JP
authors.lastname: van Straalen
authors.forename: G T
authors.initials: GT
authors.lastname: Sanders
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood*; D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood*; D011379:Prognosis; D012306:Risk; D014336:Troponin / Q000097:blood*; D020107:Troponin T
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase