Document Detail

Failure of new biochemical markers to exclude acute myocardial infarction at admission.
MedLine Citation:
PMID:  7901536     Owner:  NLM     Status:  MEDLINE    
In a substantial proportion of patients with suspected myocardial infarction, biochemical markers are needed for clinical decision-making at the time of admission, because electrocardiographic (ECG) recordings are inconclusive. We have assessed the usefulness for exclusion of myocardial infarction at admission of the newer markers creatine kinase MB (CK-MB) mass concentration, troponin T, and myoglobin in comparison with the routinely used markers creatine kinase (CK) and CK-MB activity. 290 consecutive patients were enrolled. Acute myocardial infarction was diagnosed on the basis of clinical history, ECG criteria, and time-dependent changes in CK and CK-MB activity. 153 patients had definite acute myocardial infarction. Troponin T had the highest sensitivity for prediction of acute myocardial infarction; high concentrations (above the upper reference limits) were found in 98 (64%) of the patients with infarctions compared with 92 (60%) for CK-MB mass concentration, 76 (50%) for myoglobin, 61 (40%) for CK activity, and 53 (35%) for CK-MB activity. However, troponin T also had the highest "false-positive" rate; of 137 patients without myocardial infarction, 36 (26%) had high troponin T concentrations. Sensitivity, specificity, and positive and negative predictive values were calculated in relation to time between onset of chest pain and hospital admission. Although CK-MB mass concentration was, by a small margin, the best marker in patients admitted within 8-10 h of onset of chest pain, all the markers had negative predictive values too low to allow exclusion of acute myocardial infarction at admission in patients with symptoms suggestive of myocardial infarction of less than 10 h duration.
A J Bakker; M J Koelemay; J P Gorgels; B van Vlies; R Smits; J G Tijssen; F D Haagen
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Lancet     Volume:  342     ISSN:  0140-6736     ISO Abbreviation:  Lancet     Publication Date:  1993 Nov 
Date Detail:
Created Date:  1993-12-08     Completed Date:  1993-12-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  1220-2     Citation Subset:  AIM; IM    
Department of Clinical Chemistry, Klinisch Chemisch Laboratorium, Leeuwarden, The Netherlands.
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MeSH Terms
Biological Markers
Chest Pain / diagnosis
Creatine Kinase / blood*
False Positive Reactions
Middle Aged
Myocardial Infarction / diagnosis*
Myoglobin / blood*
Patient Admission*
Predictive Value of Tests
Prospective Studies
Sensitivity and Specificity
Troponin / blood*
Troponin T
Reg. No./Substance:
0/Biological Markers; 0/Isoenzymes; 0/Myoglobin; 0/Troponin; 0/Troponin T; EC Kinase
Comment In:
Lancet. 1994 Feb 5;343(8893):363-4   [PMID:  7905180 ]
Lancet. 1993 Dec 18-25;342(8886-8887):1554   [PMID:  7902924 ]
Lancet. 1993 Dec 18-25;342(8886-8887):1553   [PMID:  7902921 ]
Lancet. 1993 Dec 18-25;342(8886-8887):1554   [PMID:  7902923 ]
Lancet. 1993 Dec 18-25;342(8886-8887):1553-4   [PMID:  7902922 ]

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