title: Comparison between cardiac troponin I and CK-MB mass in acute coronary syndrome without st elevation.
abstract: BACKGROUND
  There is uncertainty as to the comparative prognostic value between cardiac troponin I (cTnI) and CK-MB in acute coronary syndrome (ACS).
  
  
  OBJECTIVE
  To compare the prognostic value between cTnI and CK-MB mass in patients with ACS without ST-segment elevation.
  
  
  METHODS
  1,027 patients were analyzed in a prospective way in a tertiary cardiology center. Combinations of biomarkers were examined: normal cTnI, normal CK-MB mass (65.5%), normal cTnI, elevated CK-MB mass (3.9%), elevated cTnI, normal CK-MB mass (8.8%), elevated cTnI, elevated CK-MB mass (20.7%). A multivariate analysis of clinical, electrocardiographic and laboratory variables determined the independent prognostic value of biomarkers for the event of death or (re)infarction within 30 days.
  
  
  RESULTS
  Patients with at least one elevated biomarker were older (p = 0.02) and males (p < 0.001). The previous use of aspirin (p = 0.001), beta-blockers (p = 0.003) or statin (p = 0.013) was most frequent among those without elevated cTnI. Patients with both biomarkers elevated had more ST-segment depression (p < 0.001) or elevated creatinine (p < 0.001). In a multivariate analysis with the inclusion of cTnI, the CK-MB mass was not an independent variable for the event of death or (re) infarction within 30 days (odds ratio [OR] 1.16, p = 0.71). When cTnI was not included, we had the following values: age (OR 1.07; p < 0.001); male (OR 1.09; p = 0.77); diabetes mellitus (OR 1.95; p = 0.02); previous stroke (OR 3.21; p = 0.008); creatinine level (OR 1.63; p = 0.002); CK-MB mass (OR 1.96; p = 0.03). C-statistic 0.77 (p < 0.001).
  
  
  CONCLUSIONS
  With a dose of cTnI, CK-MB mass may be dispensable for prognostic evaluation. If cTnI is unavailable, CK-MB mass is acceptable for making a decision on treatment options.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil. elizabetessantos@cardiol.br
authors.forename: Elizabete Silva dos
authors.initials: ES
authors.lastname: Santos
authors.forename: Valéria Troncoso
authors.initials: VT
authors.lastname: Baltar
authors.forename: Marcos Paulo
authors.initials: MP
authors.lastname: Pereira
authors.forename: Luiz
authors.initials: L
authors.lastname: Minuzzo
authors.forename: Ari
authors.initials: A
authors.lastname: Timerman
authors.forename: Alvaro
authors.initials: A
authors.lastname: Avezum
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D015981:Epidemiologic Factors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form