The role of cardiac troponin T and other new biochemical markers in evaluation and risk stratification of patients with acute chest pain syndromes.
OBJECTIVE
Increased serum creatinine kinase (CK) and CK-MB enzyme levels have been used for years to detect myocardial infarction (MI). However, serum myoglobin and CK-MB mass or protein levels may indicate MI earlier; cardiac troponin T is the most specific marker of myocardial injury and it can detect even minor myocardial necrosis. The diagnostic and prognostic utility of the traditional and new markers of cardiac injury in the emergency evaluation of patients with acute chest pain syndromes were therefore compared.


METHODS
One hundred and fifteen consecutive patients with an acute coronary syndrome, and 64 controls recruited during the same period, were examined. The time elapsed from onset of symptoms to blood collection was recorded. Cardiac markers were measured in specimens collected upon arrival (0 h), and 2 and 5-9 h, and later in cases of longer observation. The major cardiac events occurring up to 40 months after the index examination were recorded.


RESULTS
cTnT levels provided unique information: they were the most specific indicators of myocardial damage and identified unstable angina patients at high risk of future major events. Up to 6 h after the onset of chest pain, the new markers were elevated more frequently than the traditional ones and permitted earlier MI recognition. The worst prognosis (nonfatal myocardial infarction or death) was noted in subjects with chest pain at rest within 48 h before the index examination and elevated cTnT levels.


CONCLUSIONS
The new markers, particularly cardiac troponin T, offer considerable advantages and they should be more widely used in the diagnosis and risk stratification of acute coronary syndromes.
Solymoss
B C
BC
Department of Laboratory Medicine, Montreal Heart Institute, Quebec, Canada.
Bourassa
M G
MG
Wesolowska
E
E
Dryda
I
I
Théroux
P
P
Mondor
L
L
Perrault
D
D
Gilfix
B M
BM
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000097:blood*; D000789:Angina, Unstable / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D016009:Chi-Square Distribution; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D013577:Syndrome; D013997:Time Factors; D014336:Troponin / Q000097:blood*; D020107:Troponin T
D015415:Biomarkers; D007527:Isoenzymes; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase