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European Heart Journal 2000 21(5):382-389; doi:10.1053/euhj.1999.1760
Copyright © 2000 by the European Society of Cardiology.
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Very early diagnosis and risk stratification of patients admitted with suspected acute myocardial infarction by the combined evaluation of a single serum value of cardiac troponin-T, myoglobin, and creatine kinase MBmass

B. Jurlandera,f1, P. Clemmensena, G. S. Wagnerb and P. Grandea

a The Heart Center, H:S Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
b Division of Cardiology, Duke University, NC, U.S.A.

revised June 15, 1999; accepted June 16, 1999

Abstract

Aims The diagnostic and prognostic capacity of biochemical markers of acute myocardial infarction in the emergency department were evaluated in consecutive patients (n=155) with suspected acute myocardial infarction.

Methods and Results Serum myoglobin ≥110µg.l–1and creatine kinase MBmass≥5µg.l–1had a high accuracy (0·77–0·85) (ns) for acute myocardial infarction diagnosis in patients presenting >2h after symptom onset. Troponin-T (≥0·10µg.l–1) had a lower accuracy (0·53–0·70) for acute myocardial infarction diagnosis, but was the most important 1-year prognostic marker (cardiac death or non-fatal acute myocardial infarction). In patients without ST elevation, combined analysis of two biochemical tests would accurately identify an additional 20% of acute myocardial infarction patients (predictive value of a positive test=0·82) and also identify those without acute myocardial infarction (predictive value of a negative test=0·80). One-year event-free survival was excellent (96%) for patients with two negative biochemical tests, intermediate (74%) for those with discordant tests, and only 53% for patients with two positive biochemical tests.

Conclusion Analysis of biochemical tests in the emergency department prior to hospital admission could accurately identify approximately 20% additional acute myocardial infarction patients. The prognosis of these patients is poor, and they may be a target for primary PTCA or new early initiated aggressive medical therapies.

Key Words: Myocardial infarction, diagnosis, prognosis, myoglobin, troponin-T, creatine kinase MBmass

f1 Correspondence: Birgit Jurlander, MD, PhD, Heart Center (B 2141), H:S Rigshospitalet, Copenhagen University Hospital, 9, Blegdamsvej, DK-2100 Copenhagen Ø, Denmark.

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