The relative utility of cardiac troponin I, creatine kinase-MBmass, and myosin light chain-1 in the long-term risk stratification of patients with chest pain.
BACKGROUND
Sensitive and specific cardiac markers convey important short-term prognostic information about patients with an acute coronary syndrome. There are, however, few data assessing their value as long-term predictors.


OBJECTIVE
The aim of the current study was to assess the relative value of three such markers and clinical characteristics in determining the long-term prognosis of patients with chest pain.


METHODS
Cardiac troponin I (cTnI), myosin light chain-(MLC-1), and creatine kinase-MBmass levels were obtained on admission (0 h) and at 4, 8, 16, and 24 h in 208 patients with chest pain. Eligible subjects were determined, at the time of hospital admission, to be at >7% risk of acute myocardial infarction (MI), but without new ST-segment elevation on their presenting electrocardiogram. Follow-up was performed a median of 28 (range 1-46) months later. The primary study endpoint was death or nonfatal MI, subsequent to the index admission.


RESULTS
Cardiac TnI levels > or = 0.2 ng/ml (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.09-3.40) and MLC-1 levels > or = 1 ng/ml (OR 3.24, 95% CI 1.83-5.73) were both significant predictors of death or MI during long-term follow-up; MLC-1 was, however, the only independent biochemical predictor (OR 2.11,95% CI 1.14-3.93).


CONCLUSIONS
Both cTnl and MLC-1 predict the long-term outcome of patients with chest pain, but, in this cohort, MLC-1 proved to be a better predictor of mortality and nonfatal acute MI.
Hillis
Graham S
GS
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA. grahamhillis@hotmail.com
Taggart
Pamela
P
Wardlaw
Delana
D
Hillis
Lorraine
L
Zhao
Ning
N
Dalsey
William C
WC
Mangione
Antoinette
A
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers / Q000032:analysis; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D003402:Creatine Kinase / Q000032:analysis*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality; D018994:Myosin Light Chains / Q000032:analysis*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D019210:Troponin I / Q000032:analysis*
D015415:Biomarkers; D018994:Myosin Light Chains; D019210:Troponin I; D003402:Creatine Kinase