title: Biochemical markers of acute myocardial infarction: strategies for improving their clinical usefulness.
abstract: We investigated the early diagnostic utility, including incremental value, of the serum cardiac markers creatine kinase (CK), CK-MB (mass and activity measurements), cardiac troponin T, and myoglobin in the diagnosis of acute myocardial infarction (AMI) in patients presenting to a major teaching hospital with chest pain and non-diagnostic electrocardiographs (ECG). The reference diagnosis of acute myocardial infarction was made by a single, independent cardiologist using World Health Organization criteria. CK and CK-MB mass were the only significant predictors of AMI at presentation to the Emergency Department. Logistic regression analysis revealed that CK did not significantly predict (P = 0.23) myocardial infarction once CK-MB mass was in the model. Using test results on follow up, in addition to presentation CK-MB mass, change in CK-MB mass was the only other significant independent predictor of AMI. Likelihood ratios for various levels of the significant markers in the logistic regression are given. In conclusion, CK-MB mass measurement was the only useful serum cardiac marker for the diagnosis of AMI in patients presenting with chest pain with non-diagnostic ECGs.
authors.affiliation: Department of Biochemistry, Royal North Shore Hospital, St Leonards, NSW, Australia. kitkatz@bigpond.com.au
authors.forename: I A
authors.initials: IA
authors.lastname: Katz
authors.forename: L
authors.initials: L
authors.lastname: Irwig
authors.forename: J D
authors.initials: JD
authors.lastname: Vinen
authors.forename: L
authors.initials: L
authors.lastname: March
authors.forename: L E
authors.initials: LE
authors.lastname: Wyndham
authors.forename: T
authors.initials: T
authors.lastname: Luu
authors.forename: G I
authors.initials: GI
authors.lastname: Nelson
mesh_terms: D015415:Biomarkers / Q000097:blood*; D003402:Creatine Kinase / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism; D009211:Myoglobin / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D014336:Troponin / Q000097:blood*; D020107:Troponin T
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D014336:Troponin; D020107:Troponin T; D003402:Creatine Kinase