Rapid risk stratification in suspected acute coronary syndrome using serial multiple cardiac biomarkers: a pilot study.
OBJECTIVE
To determine the feasibility of using a biomarker panel of myoglobin, creatinine kinase MB (CK-MB) and cardiac troponin I (cTnI) to identify patients with suspected acute coronary syndrome (ACS) who are suitable for discharge within 2 h.


METHODS
We took blood at presentation and at 2 h from patients with suspected ACS and non-diagnostic electrocardiogram who were admitted to the ED short stay ward for serial electrocardiogram and troponin testing. We used a point-of-care device that gives rapid estimation of myoglobin, CK-MB and cTnI (Triage cardiac panel). These results were compared with the results of our standard hospital cardiac troponin T assay. Patients were followed up by telephone at 30 days.


RESULTS
The study group comprised 100 patients (61 men) with mean age of 58 years. Six had a troponin-positive ACS during their ED stay. One additional patient died of a myocardial infarction within the follow-up period. The Triage panel at 2 h after presentation predicted 12-h cardiac troponin T elevation (sensitivity 100%, negative predictive value 99%) and 30-day events (sensitivity 86%, negative predictive value 97%). The majority of patients were ultimately suitable for discharge.


CONCLUSIONS
Serial myoglobin, CK-MB and cTnI have the potential to identify patients who are suitable for early discharge and outpatient work-up. A large multicentre study is required.
Macdonald
Stephen P J
SP
Emergency Department, Armadale Health Service, Armadale, Western Australia, Australia. stephen.macdonald@health.wa.gov.au
Nagree
Yusuf
Y
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000209:etiology; D052279:Creatine Kinase, MB Form / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019095:Point-of-Care Systems; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form