文摘
Limitations of creatine kinase-MB (CK-MB) have led to alternative biochemical markers, including troponin T (TnT), to detect myocardial necrosis. Limited data are available regarding the predictive value of this new marker in patients with chest pain of uncertain etiology. Therefore, we prospectively compared CK-MB and TnT in a broad population with suspected acute coronary syndromes, including those admitted to a short-stay chest pain unit. CK-MB, quantitative TnT levels, and a rapid bedside assay were performed at 0, 4, 8, and 16 hours. Adverse events, including infarction, recurrent ischemia, coronary surgery, need for catheterization and/or intervention, stroke, congestive heart failure, or death, were identified by chart review and by follow-up phone call at 6 months. Of 707 patients, 104 were excluded for creatinine >2 mg/dl or incomplete data, leaving a total cohort of 603 patients. Coronary Care Unit admissions were 18 % , intermediate care admissions were 14 % , telemetry admissions is 21 % , and admissions to 24-hour short-stay area were 47 % . TnT (at 0.1 ng/ml) and CK-MB were positive in a similar proportion of patients (20.4 % and 19.7 % , respectively); however, the patients identified by TnT and CK-MB were not identical. In-hospital adverse events occurred in 37.1 % with no differences in positive predictive value for the markers (p = NS). If CK-MB and TnT were negative, the early adverse event rate was 27 % . No cardiac marker was positive by 16 hours in 54.9 % of patients with an adverse event. Six-month follow-up was obtained in 576 of the 603 patients (95.5 % ). One hundred fifty-five late adverse events occurred in 134 patients (23.3 % ) at an average of 3.3 ± 2.5 months after discharge. If both markers were negative, the late event rate was 20.2 % and did not increase in patients with positive CK-MB or TnT >0.2 ng/ml. However, the late event rate was substantially higher (52.9 % ) in those with intermediate TnT levels of 0.1 to 0.2 ng/ml (p = 0.002). Thus, TnT is a suitable alternative to CK-MB in patients with suspected acute coronary syndromes. The rapid bedside assay is comparable to quantitative TnT and may enable early diagnosis and triage. A negative cardiac marker value (TnT or CK-MB) does not necessarily confer a low risk of complication in patients presenting with acute chest pain to an emergency department.
