Combining different biochemical markers of myocardial ischemia does not improve risk stratification in chest pain patients compared to troponin I alone.
OBJECTIVE
Early evaluation of patients with chest pain is important not only for the detection of acute myocardial infarction (AMI) but also for identification of patients at high risk for future cardiac events. A multimarker strategy applying results of early measurements of different biochemical markers of cardiac necrosis in combination may improve risk prediction in chest pain patients.


METHODS
Rapid measurements of troponin I (TnI), creatine kinase MB and myoglobin were performed in 191 consecutive patients with chest pain and a non-diagnostic electrocardiogram for AMI. The prognostic value of these markers and different multimarker strategies was evaluated and compared.


RESULTS
Ten (5.2%) patients died during follow-up, which for eight (4.2%) patients was due to cardiac causes. Myocardial reinfarctions occurred in 17 (6.8%) patients. TnI was most predictive for cardiac mortality (TnI>or=0.1 microg/l, 10.7% event rate compared with TnI<0.1 microg/l, 0%, P<0.001) and myocardial reinfarction (14.9% compared with 1.7%, P<0.001). The other markers and multimarker strategies had a lower capacity for predicting adverse events apart from myoglobin and the combination of TnI or myoglobin regarding the endpoint of total mortality.


CONCLUSIONS
The combinations of different markers were prognostically non-superior compared to TnI, which thus, should be preferred as a biochemical marker for risk stratification in patients with chest pain.
Eggers
Kai M
KM
Department of Cardiology, University Hospital, Uppsala, Sweden. kai.eggers@akademiska.se
Oldgren
Jonas
J
Nordenskjöld
Anna
A
Lindahl
Bertil
B
D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D009211:Myoglobin / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014218:Triage; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D052279:Creatine Kinase, MB Form