title: Validation of NACB and IFCC guidelines for the use of cardiac markers for early diagnosis and risk assessment in patients with acute coronary syndromes.
abstract: BACKGROUND
  International guidelines have been established for the use of cardiac markers in the early diagnosis and risk assessment of patients with acute coronary syndromes.
  
  
  METHODS
  A single center, prospective observational study was conducted in a tertiary care university hospital on 200 consecutive patients with suspected acute myocardial infarction (AMI). Blood was drawn on admission and after 2, 4, 8, 12 and 24 h for the measurement of CK-MB/CK activity, myoglobin, CK-MB mass and troponin I. A 6-week follow-up was undertaken for the combined end point of acute coronary syndrome and death.
  
  
  RESULTS
  Myoglobin showed an early diagnostic sensitivity of 0.65 on admission, 0.90 after 2 h and 0.92 after 4 h compared with 0.46, 0.74 and 0.88 for CK-MB/CK activity. The combination of myoglobin and cTnI increased the diagnostic value compared with myoglobin alone on admission, 2 and 4 h later. In multivariate analysis, cTnI and CK-MB/CK mass, but not myoglobin and CK-MB/CK activity, were shown to be independent predictors on the 6-week follow-up.
  
  
  CONCLUSIONS
  Repetitive myoglobin measurements within 4 h of admission, combined with at least one early troponin test, was shown to be the strategy of choice in early AMI diagnosis and prognosis assessment.
authors.affiliation: Department of Medicine, Internal Intensive Care, Charité/Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. martin.moeckel@charite.de
authors.forename: M
authors.initials: M
authors.lastname: Möckel
authors.forename: W
authors.initials: W
authors.lastname: Gerhardt
authors.forename: G
authors.initials: G
authors.lastname: Heller
authors.forename: F
authors.initials: F
authors.lastname: Klefisch
authors.forename: O
authors.initials: O
authors.lastname: Danne
authors.forename: J
authors.initials: J
authors.lastname: Maske
authors.forename: C
authors.initials: C
authors.lastname: Müller
authors.forename: T
authors.initials: T
authors.lastname: Störk
authors.forename: U
authors.initials: U
authors.lastname: Frei
authors.forename: A H
authors.initials: AH
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis*; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D009211:Myoglobin / Q000097:blood; D011446:Prospective Studies; D018570:Risk Assessment; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form