Rapid assessment of patients with non-ST-segment elevation acute chest pain: troponins, inflammatory markers, or perfusion imaging?
BACKGROUND
Perfusion imaging during or soon after pain has been shown to provide diagnostic and prognostic information in patients with suspected angina. Measurement of troponin I (TnI) and troponin T (TnT) provides similar information but only several hours after onset of pain. The role of inflammatory markers in this setting is less clear.


RESULTS
We prospectively studied 80 nonconsecutive patients using gated technetium 99m sestamibi single photon emission computed tomography (MIBI), TnT, TnI, C-reactive protein, IL-6, and tumor necrosis factor alpha. Of these patients, 50 (63%) had abnormal MIBI, 13 (17%) had elevated TnT, 17 (21%) had elevated TnI, and C-reactive protein, IL-6, and tumor necrosis factor alpha were raised in 46 (58%), 14 (18%), and 29 (37%), respectively. Myocardial infarction was the presenting event in 13 patients (16%), and 23 (34%) of those without index myocardial infarction sustained a cardiovascular event during follow-up. MIBI, TnT, TnI, and electrocardiogram all had similar negative predictive values for index myocardial infarction (97%, 97%, 95%, and 97%, respectively). However, only MIBI had a high negative predictive value for the prediction of subsequent events during follow-up (86%). TnT and MIBI were the only independent predictors of all events. Inflammatory markers provided no useful additional prognostic information.


CONCLUSIONS
The combination of TnT and MIBI is the best model for early prediction of cardiac events in patients with acute chest pain.
D000208:Acute Disease; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D002637:Chest Pain / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D017256:Technetium Tc 99m Sestamibi; D014336:Troponin / Q000097:blood*; D019210:Troponin I / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D015415:Biomarkers; D015850:Interleukin-6; D019275:Radiopharmaceuticals; D014336:Troponin; D019210:Troponin I; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D017256:Technetium Tc 99m Sestamibi