Risk stratification of chest pain patients by point-of-care cardiac troponin T and myoglobin measured in the emergency department.
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.
Ordóñez-Llanos
Jordi
J
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Santaló-Bel
Miquel
M
Mercé-Muntañola
Javier
J
Collinson
Paul O
PO
Gaze
David
D
Haass
Markus
M
Katus
Hugo A
HA
Chwallek
Frank
F
Hirschl
Michael M
MM
Derhaschnig
Ulla
U
Mueller-Bardorff
Margit
M
Kellett
John
J
Sylvén
Christer
C
Schulz
Ilse
I
Zerback
Rainer
R
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*
D009211:Myoglobin; D020107:Troponin T; D052279:Creatine Kinase, MB Form