[Qualitative determination of markers for myocardiac necrosis during pre-hospital admission for acute coronary syndrome].
OBJECTIVE
We measured the diagnostic value of troponin I (TnI), mioglobin (Miog) and creatine kinase MB (CPK-MB) in patients with thoracic pain during the period of preadmission to the hospital.


METHODS
We included patients who requested prehospital attention with intensive therapy ambulance or who were in the first hours of hospitalization for thoracic pain. A 12-lead electrocardiogram was carried out in the ambulance or in the emergency room. The levels of total creatine phosphokinase were determined (as reference pattern). Five study groups were included: group I, 13 patients with acute myocardial infarction without elevation of the ST segment; group II, 11 patients with unstable angina; group III, 14 patients with atypical thoracic pain for angina; group IV, five healthy patients; and group V, five patients with acute myocardial infarction with elevation of the ST segment. A qualitative evaluation was made with an automatic device for quick interpretation of TnI, Miog and CPK-MB.


RESULTS
Forty eight patients were studied with an average age of 55+/-18 years, 25 men (52%) and 23 women (48%), average time of symptom evolution was 3.5 h (quartiles 2 and 6 h). Total level of CPK was taken as a reference pattern. Sensitivity of TnI, Miog, and CPK-MB was 100%, specificity was 94, 91 and 94%, respectively. Positive predictive value was 89, 84 and 89%, respectively. Negative predictive value was 100%. Likelihood of probability was 8.7, 5.5 and 8.7, respectively.


CONCLUSIONS
TnI, Miog and CPK-MB have high diagnostic value in acute coronary syndrome (ACS) from the time of prehospital admission. Determination is advisable as part of the diagnostic protocol, which is of great importance in order to plan the hospitalization and treatment in this group of patients.
Borrayo-Sánchez
Gabriela
G
Unidad de Cuidados Intensivos Cardiovasculares, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtemoc 330, Col. Doctores, 06725 México, D.F., México. gborrayos@yahoo.com.mx
Sosa-Jarero
Fernando
F
Borja-Terán
Bulmaro
B
Isordia-Salas
Irma
I
Argüero-Sánchez
Rubén
R
D000208:Acute Disease; D000789:Angina, Unstable / Q000097:blood* / Q000473:pathology*; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D009211:Myoglobin / Q000097:blood*; D009336:Necrosis; D013577:Syndrome; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D052279:Creatine Kinase, MB Form