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. 1996 Mar;75(3):235–239. doi: 10.1136/hrt.75.3.235

Prognostic value of troponin T, myoglobin, and CK-MB mass in patients presenting with chest pain without acute myocardial infarction.

R J de Winter 1, R W Koster 1, J H Schotveld 1, A Sturk 1, J P van Straalen 1, G T Sanders 1
PMCID: PMC484278  PMID: 8800984

Abstract

OBJECTIVE: To assess the prognostic value of minor myocardial damage in patients presenting with chest pain without myocardial infarction. DESIGN: The relative risk of suffering a cardiac event in the next six months was assessed in patients with minor myocardial damage assessed by the cardiac markers CK-MB, myoglobin, and troponin T. SETTING: Emergency department of a large university hospital. PATIENTS: In 128 consecutive patients with chest pain, acute myocardial infarction (by WHO criteria) was ruled out; of these, 39 had a rise and fall of one or more markers, indicating minor myocardial damage. The presence of a documented history of coronary artery disease was assessed on admission. RESULTS: 24 patients had a subsequent event (cardiac death, acute myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting) in the next six months. An abnormal troponin T predicted a subsequent event while abnormal CK-MB or myoglobin did not. The relative risk for troponin T was 2.8 (95% confidence interval: 1.0 to 7.9), for myoglobin 1.0 (0.3 to 3.2), and for CK-MB 0.9 (0.2 to 3.4). A documented history of coronary artery disease predicted subsequent events with a relative risk of 3.9 (1.3 to 11.3). CONCLUSIONS: Troponin T was the only marker that predicted future events, but a documented history of coronary artery disease was the best predictor in patients in whom an acute myocardial infarction had been ruled out.

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Selected References

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  1. Adams J. E., 3rd, Abendschein D. R., Jaffe A. S. Biochemical markers of myocardial injury. Is MB creatine kinase the choice for the 1990s? Circulation. 1993 Aug;88(2):750–763. doi: 10.1161/01.cir.88.2.750. [DOI] [PubMed] [Google Scholar]
  2. Apple F. S. Acute myocardial infarction and coronary reperfusion. Serum cardiac markers for the 1990s. Am J Clin Pathol. 1992 Feb;97(2):217–226. doi: 10.1093/ajcp/97.2.217. [DOI] [PubMed] [Google Scholar]
  3. Bakker A. J., Koelemay M. J., Gorgels J. P., van Vlies B., Smits R., Tijssen J. G., Haagen F. D. Troponin T and myoglobin at admission: value of early diagnosis of acute myocardial infarction. Eur Heart J. 1994 Jan;15(1):45–53. doi: 10.1093/oxfordjournals.eurheartj.a060378. [DOI] [PubMed] [Google Scholar]
  4. Braunwald E. Unstable angina. A classification. Circulation. 1989 Aug;80(2):410–414. doi: 10.1161/01.cir.80.2.410. [DOI] [PubMed] [Google Scholar]
  5. Chapelle J. P., Albert A., Smeets J. P., Boland J., Heusghem C., Kulbertus H. E. Serum myoglobin determinations in the assessment of acute myocardial infarction. Eur Heart J. 1982 Apr;3(2):122–129. doi: 10.1093/oxfordjournals.eurheartj.a061273. [DOI] [PubMed] [Google Scholar]
  6. Chapelle J. P., Heusghem C. Semi-quantitative estimation of serum myoglobin by a rapid latex agglutination method: an emergency screening test for acute myocardial infarction. Clin Chim Acta. 1985 Jan 30;145(2):143–150. doi: 10.1016/0009-8981(85)90281-5. [DOI] [PubMed] [Google Scholar]
  7. Gerhardt W., Katus H. A., Ravkilde J., Hamm C. W. S-troponin-T as a marker of ischemic myocardial injury. Clin Chem. 1992 Jun;38(6):1194–1195. [PubMed] [Google Scholar]
  8. Gerhardt W., Katus H., Ravkilde J., Hamm C., Jørgensen P. J., Peheim E., Ljungdahl L., Löfdahl P. S-troponin T in suspected ischemic myocardial injury compared with mass and catalytic concentrations of S-creatine kinase isoenzyme MB. Clin Chem. 1991 Aug;37(8):1405–1411. [PubMed] [Google Scholar]
  9. Hamm C. W., Ravkilde J., Gerhardt W., Jørgensen P., Peheim E., Ljungdahl L., Goldmann B., Katus H. A. The prognostic value of serum troponin T in unstable angina. N Engl J Med. 1992 Jul 16;327(3):146–150. doi: 10.1056/NEJM199207163270302. [DOI] [PubMed] [Google Scholar]
  10. Heyndrickx G. R., Amano J., Kenna T., Fallon J. T., Patrick T. A., Manders W. T., Rogers G. G., Rosendorff C., Vatner S. F. Creatine kinase release not associated with myocardial necrosis after short periods of coronary artery occlusion in conscious baboons. J Am Coll Cardiol. 1985 Dec;6(6):1299–1303. doi: 10.1016/s0735-1097(85)80216-3. [DOI] [PubMed] [Google Scholar]
  11. Isakov A., Shapira I., Burke M., Almog C. Serum myoglobin levels in patients with ischemic myocardial insult. Arch Intern Med. 1988 Aug;148(8):1762–1765. [PubMed] [Google Scholar]
  12. Katus H. A., Looser S., Hallermayer K., Remppis A., Scheffold T., Borgya A., Essig U., Geuss U. Development and in vitro characterization of a new immunoassay of cardiac troponin T. Clin Chem. 1992 Mar;38(3):386–393. [PubMed] [Google Scholar]
  13. Katus H. A., Remppis A., Neumann F. J., Scheffold T., Diederich K. W., Vinar G., Noe A., Matern G., Kuebler W. Diagnostic efficiency of troponin T measurements in acute myocardial infarction. Circulation. 1991 Mar;83(3):902–912. doi: 10.1161/01.cir.83.3.902. [DOI] [PubMed] [Google Scholar]
  14. Lee T. H., Goldman L. Serum enzyme assays in the diagnosis of acute myocardial infarction. Recommendations based on a quantitative analysis. Ann Intern Med. 1986 Aug;105(2):221–233. doi: 10.7326/0003-4819-105-2-221. [DOI] [PubMed] [Google Scholar]
  15. Mair J., Artner-Dworzak E., Lechleitner P., Smidt J., Wagner I., Dienstl F., Puschendorf B. Cardiac troponin T in diagnosis of acute myocardial infarction. Clin Chem. 1991 Jun;37(6):845–852. [PubMed] [Google Scholar]
  16. Ohman E. M., Casey C., Bengtson J. R., Pryor D., Tormey W., Horgan J. H. Early detection of acute myocardial infarction: additional diagnostic information from serum concentrations of myoglobin in patients without ST elevation. Br Heart J. 1990 Jun;63(6):335–338. doi: 10.1136/hrt.63.6.335. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Stone M. J., Waterman M. R., Harimoto D., Murray G., Willson N., Platt M. R., Blomqvist G., Willerson J. T. Serum myoglobin level as diagnostic test in patients with acute myocardial infarction. Br Heart J. 1977 Apr;39(4):375–380. doi: 10.1136/hrt.39.4.375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. White R. D., Grande P., Califf L., Palmeri S. T., Califf R. M., Wagner G. S. Diagnostic and prognostic significance of minimally elevated creatine kinase-MB in suspected acute myocardial infarction. Am J Cardiol. 1985 Jun 1;55(13 Pt 1):1478–1484. doi: 10.1016/0002-9149(85)90957-9. [DOI] [PubMed] [Google Scholar]
  19. Yusuf S., Collins R., Lin L., Sterry H., Pearson M., Sleight P. Significance of elevated MB isoenzyme with normal creatine kinase in acute myocardial infarction. Am J Cardiol. 1987 Feb 1;59(4):245–250. doi: 10.1016/0002-9149(87)90793-4. [DOI] [PubMed] [Google Scholar]

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