Biochemical markers of ischaemia for the early identification of acute myocardial infarction without St segment elevation.
Blood was collected on admission and after 1-2 h in 130 consecutive patients admitted with typical chest pain in order to assess the capacity of myoglobin, fatty-acid-binding protein (FABP), CK-MB mass, and troponin I (TnI) in the early identification of acute myocardial infarction (AMI) without ST elevation. Using the maximum value within 6 h of onset of symptoms, AMI was detected with a 90-95% sensitivity and a 81-94% specificity by FABP at a cut-off level 8-12 midrog/l, or 81-86% and 89-93%, respectively, by myoglobin at a cut-off level 70-90 microg/l. CK-MB mass and TnI had low sensitivity, albeit very high specificity. As almost all AMI patients were identified within 6 h, serial measurements of FABP or myoglobin ruled out AMI with a very high degree of certainty. Due to the low prevalence of AMI (16%), the positive predictive values were modest (47-73%), yet increasing the probability of AMI by a factor 3-4. Myoglobin and FABP are very useful markers in the early triage of chest pain patients.
Haastrup
B
B
Department of Cardiology, Odense University Hospital, Odense C, Denmark. B.Haastrup@dadlnet.dk
Gill
S
S
Kristensen
S R
SR
Jørgensen
P J
PJ
Glatz
J F
JF
Haghfelt
T
T
Hørder
M
M
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002352:Carrier Proteins / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004562:Electrocardiography; D000071438:Fatty Acid-Binding Protein 7; D050556:Fatty Acid-Binding Proteins; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000473:pathology*; D017202:Myocardial Ischemia / Q000097:blood / Q000473:pathology*; D009211:Myoglobin / Q000032:analysis; D009363:Neoplasm Proteins; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood; D025521:Tumor Suppressor Proteins
D015415:Biomarkers; D002352:Carrier Proteins; C107608:FABP7 protein, human; D000071438:Fatty Acid-Binding Protein 7; D050556:Fatty Acid-Binding Proteins; D007527:Isoenzymes; D009211:Myoglobin; D009363:Neoplasm Proteins; D019210:Troponin I; D025521:Tumor Suppressor Proteins; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form