title: Risk stratification of chest pain patients by point-of-care cardiac troponin T and myoglobin measured in the emergency department.
abstract: A prospective multicenter study including 1410 chest pain patients with suspected acute coronary syndromes was carried out to examine the predictive value of biological cardiac markers for adverse events measured by a point-of-care system. Admission cardiac troponin T (cTnT) and myoglobin were measured in parallel on a point-of-care system in the emergency department and -- together with CK-MB mass -- on lab analyzers. In a one-year follow-up, cardiac and non-cardiac death, acute myocardial infarction, unstable angina pectoris and need for revascularization were registered. Median time between onset of symptoms and admission was 285 min; 172 patients (12.2%) had no event during follow-up. If the cTnT, measured either by the point-of-care system or a conventional lab analyzer, was >0.05 microg/L, then the chance of a cardiac event during the follow-up period was doubled (18% vs. 9%). Serial cTnT measurement did not add any further value to the predictive power of the admission cTnT. Myoglobin and CK-MB mass identified increasing risk with increasing concentration quartiles; cardiac event rates were 2.8- to 4.4-fold higher between the quartiles with the lowest and those with the highest analyte concentration, respectively. There was no difference in non-cardiac death rates between any concentration quartiles. In conclusion, the prediction of clinical events by cardiac troponin T and myoglobin measured with a point-of-care analyzer in the emergency department was as good as that of the same cardiac markers and CK-MB mass measured on lab analyzers.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Ordóñez-Llanos
authors.forename: Miquel
authors.initials: M
authors.lastname: Santaló-Bel
authors.forename: Javier
authors.initials: J
authors.lastname: Mercé-Muntañola
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.forename: David
authors.initials: D
authors.lastname: Gaze
authors.forename: Markus
authors.initials: M
authors.lastname: Haass
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Frank
authors.initials: F
authors.lastname: Chwallek
authors.forename: Michael M
authors.initials: MM
authors.lastname: Hirschl
authors.forename: Ulla
authors.initials: U
authors.lastname: Derhaschnig
authors.forename: Margit
authors.initials: M
authors.lastname: Mueller-Bardorff
authors.forename: John
authors.initials: J
authors.lastname: Kellett
authors.forename: Christer
authors.initials: C
authors.lastname: Sylvén
authors.forename: Ilse
authors.initials: I
authors.lastname: Schulz
authors.forename: Rainer
authors.initials: R
authors.lastname: Zerback
mesh_terms: D000368:Aged; D002637:Chest Pain; D052279:Creatine Kinase, MB Form / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood*; D019095:Point-of-Care Systems; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D009211:Myoglobin; D020107:Troponin T; D052279:Creatine Kinase, MB Form