Risk stratification of chest pain patients by point-of-care cardiac troponin T and myoglobin measured in the emergency department

Clin Chim Acta. 2006 Mar;365(1-2):93-7. doi: 10.1016/j.cca.2005.07.035. Epub 2005 Oct 7.

Abstract

A prospective multicenter study including 1410 chest pain patients with suspected acute coronary syndromes was carried out to examine the predictive value of biological cardiac markers for adverse events measured by a point-of-care system. Admission cardiac troponin T (cTnT) and myoglobin were measured in parallel on a point-of-care system in the emergency department and -- together with CK-MB mass -- on lab analyzers. In a one-year follow-up, cardiac and non-cardiac death, acute myocardial infarction, unstable angina pectoris and need for revascularization were registered. Median time between onset of symptoms and admission was 285 min; 172 patients (12.2%) had no event during follow-up. If the cTnT, measured either by the point-of-care system or a conventional lab analyzer, was >0.05 microg/L, then the chance of a cardiac event during the follow-up period was doubled (18% vs. 9%). Serial cTnT measurement did not add any further value to the predictive power of the admission cTnT. Myoglobin and CK-MB mass identified increasing risk with increasing concentration quartiles; cardiac event rates were 2.8- to 4.4-fold higher between the quartiles with the lowest and those with the highest analyte concentration, respectively. There was no difference in non-cardiac death rates between any concentration quartiles. In conclusion, the prediction of clinical events by cardiac troponin T and myoglobin measured with a point-of-care analyzer in the emergency department was as good as that of the same cardiac markers and CK-MB mass measured on lab analyzers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chest Pain*
  • Creatine Kinase, MB Form / blood
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / diagnosis*
  • Myoglobin / blood*
  • Point-of-Care Systems*
  • Risk Assessment
  • Sensitivity and Specificity
  • Troponin T / blood*

Substances

  • Myoglobin
  • Troponin T
  • Creatine Kinase, MB Form