Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Troponin T and myoglobin at admission: value of early diagnosis of acute myocardial infarction
*Deapartments of Clinical Chemistry, Medisch Centrum Leeuwarden Amsterdam, The Netherlands
||Deapartments of Clinical Epidemiology and Biostatistics, Academish Medisch Centrum Amsterdam, The Netherlands
Deapartments of Clinical Chemistry, Academish Medisch Centrum Amsterdam, The Netherlands
Deapartments of Cardiology, Academish Medisch Centrum Amsterdam, The Netherlands
Deapartments of Cardiology, Medisch Centrum Leeuwarden Amsterdam, The Netherlands
Received 1 May 1993; revised 1 July 1993; .
Correspondence: A J Bakker, Department of Clinical Chemistry, Klinisch Chemisch Laboratorium, P.O. Box 850, 8901 BR Leeuwarden, The Netherlands
Abstract
We studied the predictive power at admission of troponin T and myoglobin and compared them with that of CK and CK-MB activity and ECG in 290 consecutive patients admitted for evaluation of a suspected AMI. The likelihood ratio for an ischaemic ECG at admission <4 h (between 4 and 12 h) after onset of chest pain was 2·85 (1·92), for a inconclusive ECG 1·53 (1·98) and for a normal ECG 0·27 (0·35). In patients admitted <4 h after onset of chest pain, the likelihood ratio for abnormal and normal nyoglobin concentrations (8·06 and 0·67) was considerably better for detection of AMI as defined by the WHO criteria than for the other markers, including the ECG. In patients admitted 4–12 h after onset of chest pain, the likelihood ratios for abnormal and normal myoglobin concentrations were 4·88 and 0·42; for troponin T 3·11 and 0·31, for CK activity 3·44 and 0·49 and for CK-MB activity 4·08 and 0·54 respectively. The sensitivity for troponin T (64%) was better than that of the other markers but its specificity (74%)was worse, because in patients with unstable angina troponin T was frequently elevated (37%). Stepwise logistic regression analysis showed that the best predictors of AMI within 4 h after onset of chest pain were the ECG and myoglobin and between 4–12 h after onset of chest pain the ECG, CK-MB activity and myoglobin.
Key Words: Acute myocardial infarction • early diagnosis • unstable angina pectoris • troponin T • myoglobin CK-MB activity • CK • diagnostic use
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