Document Detail


Evaluation of a proposed panel of cardiac markers for the diagnosis of acute myocardial infarction in patients with atraumatic chest pain.
MedLine Citation:
PMID:  9648898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to evaluate retrospectively the efficacy of a proposed panel of three cardiac markers (myoglobin, creatine kinase-MB mass [CK-MB], and cardiac troponin I) in the diagnosis of acute myocardial infarction (AMI) in patients with atraumatic chest pain. DESIGN: A total of 110 patients admitted for the evaluation of atraumatic chest pain were examined. Forty-one of these patients were diagnosed with AMI. RESULTS: Five of the 41 patients with AMI had abnormally elevated myoglobin levels, whereas values of CK-MB and/or cardiac troponin I remained negative. Creatine kinase-MB mass alone had a sensitivity of 92.7%, a specificity of 89.9%, a positive predictive value of 84.4%, and a negative predictive value of 95.0% for the diagnosis of AMI. Cardiac troponin I alone had a sensitivity of 90.2%, a specificity of 95.7%, a positive predictive value of 92.5%, and a negative predictive value of 94.3% for the diagnosis of AMI. Cardiac troponin I is a more specific marker for the diagnosis of AMI than CK-MB, particularly in patients with chronic renal failure who are evaluated for chest pain. The combination of CK-MB and cardiac troponin I increased the sensitivity to 100% and the negative predictive value to 100% and had a specificity of 88.4% and a positive predictive value of 83.7%. The panel was diagnostic for all patients with AMI within 12 hours after admission. CONCLUSIONS: Our preliminary results indicate that this panel is highly effective for evaluation of AMI in patients with atraumatic chest pain. Elevated myoglobin levels were useful in detecting patients at high risk for AMI who initially were not detected with other markers. The combination of CK-MB and cardiac troponin I provided much higher sensitivity and had a much higher negative predictive value for the evaluation of AMI than cardiac troponin I or CK-MB alone. The 100% negative predictive value is particularly important because it indicates that patients with negative CK-MB and cardiac troponin I values 12 hours after admission have a negligible likelihood of AMI.
Authors:
C C Chang; M P Ip; R M Hsu; T Vrobel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of pathology & laboratory medicine     Volume:  122     ISSN:  0003-9985     ISO Abbreviation:  Arch. Pathol. Lab. Med.     Publication Date:  1998 Apr 
Date Detail:
Created Date:  1998-07-10     Completed Date:  1998-07-10     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7607091     Medline TA:  Arch Pathol Lab Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  320-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Pathology, MetroHealth Medical Center, Cleveland, Ohio 44109-1998, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers*
Chest Pain*
Creatine Kinase / blood
Female
Humans
Isoenzymes
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myoglobin / blood
Reference Values
Sensitivity and Specificity
Troponin I / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Isoenzymes; 0/Myoglobin; 0/Troponin I; EC 2.7.3.2/Creatine Kinase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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