title: The prognostic significance of serial myoglobin, troponin I, and creatine kinase-MB measurements in patients evaluated in the emergency department for acute coronary syndrome.
abstract: OBJECTIVE
  We sought to determine the value of serial measurements of myoglobin, cardiac troponin I (cTnI), and creatine kinase-MB (CK-MB) to predict 30-day adverse events in patients evaluated in the emergency department (ED) for possible acute coronary syndrome.
  
  
  METHODS
  Serum myoglobin, cTnI, and CK-MB levels were measured at presentation, 90 minutes, 3 hours, and 9 hours in patients evaluated in the ED for possible acute coronary syndrome. In 764 consecutive patients, the ability of each individual marker and combination of markers to predict a 30-day adverse event (death or myocardial infarction) over time was calculated.
  
  
  RESULTS
  There were 109 (14%) patients with an adverse event at 30 days (84 myocardial infarctions and 43 deaths). The sensitivities of initial measurements of myoglobin, cTnI, and CK-MB for identifying adverse events were 60%, 47%, and 52%, respectively. The combined sensitivity of myoglobin and cTnI measurements during a 9-hour period was 94%; specificity was 50%. Measurement of CK-MB did not improve sensitivity.
  
  
  CONCLUSIONS
  The measurement of both myoglobin and cTnI during a 9-hour period was the most predictive of subsequent adverse events in patients evaluated in the ED for possible acute coronary syndrome.
authors.affiliation: Henry Ford Heart and Vascular Institute, Detroit, MI 48202, USA. jmccord1@hfhs.org
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.forename: Michael P
authors.initials: MP
authors.lastname: Hudson
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Michael C
authors.initials: MC
authors.lastname: Tomlanovich
authors.forename: Gordon
authors.initials: G
authors.lastname: Jacobsen
authors.forename: Glenn
authors.initials: G
authors.lastname: Tokarski
authors.forename: Nabil
authors.initials: N
authors.lastname: Khoury
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Weaver
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000097:blood* / Q000401:mortality; D003402:Creatine Kinase / Q000097:blood*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase