Bedside multimarker testing for risk stratification in chest pain units: The chest pain evaluation by creatine kinase-MB, myoglobin, and troponin I (CHECKMATE) study.
BACKGROUND
Earlier, rapid evaluation in chest pain units may make patient care more efficient. A multimarker strategy (MMS) testing for several markers of myocardial necrosis with different time-to-positivity profiles also may offer clinical advantages.


RESULTS
We prospectively compared bedside quantitative multimarker testing versus local laboratory results (LL) in 1005 patients in 6 chest pain units. Myoglobin, creatine kinase-MB, and troponin I were measured at 0, 3, 6, 9 to 12, and 16 to 24 hours after admission. Two MMS were defined: MMS-1 (all 3 markers) and MMS-2 (creatine kinase-MB and troponin I only). The primary assessment was to relate marker status with 30-day death or infarction. More patients were positive by 24 hours with MMS than with LL (MMS-1, 23.9%; MMS-2, 18.8%; LL, 8.8%; P=0.001, all comparisons), and they became positive sooner with MMS-1 (2.5 hours, P=0.023 versus LL) versus MMS-2 (2.8 hours, P=0.026 versus LL) or LL (3.4 hours). The relation between baseline MMS status and 30-day death or infarction was stronger (MMS-1: positive, 18.8% event rate versus negative, 3.0%, P=0.001; MMS-2: 21.9% versus 3.2%, P=0.001) than that for LL (13.6% versus 5.5%, P=0.038). MMS-1 discriminated 30-day death better (positive, 2.0% versus negative, 0.0%, P=0.007) than MMS-2 (positive, 1.8% versus negative, 0.2%; P=0.055) or LL (positive, 0.0% versus negative, 0.5%; P=1.000).


CONCLUSIONS
Rapid multimarker analysis identifies positive patients earlier and provides better risk stratification for mortality than a local laboratory-based, single-marker approach.
Newby
L K
LK
Duke Clinical Research Institute, Durham, NC, USA. newby001@mc.duke.edu
Storrow
A B
AB
Gibler
W B
WB
Garvey
J L
JL
Tucker
J F
JF
Kaplan
A L
AL
Schreiber
D H
DH
Tuttle
R H
RH
McNulty
S E
SE
Ohman
E M
EM
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D011237:Predictive Value of Tests; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase