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  • Title: Risk stratification of chest pain patients by point-of-care cardiac troponin T and myoglobin measured in the emergency department.
    Author: Ordóñez-Llanos J, Santaló-Bel M, Mercé-Muntañola J, Collinson PO, Gaze D, Haass M, Katus HA, Chwallek F, Hirschl MM, Derhaschnig U, Mueller-Bardorff M, Kellett J, Sylvén C, Schulz I, Zerback R, CARMYT Multicentre Study Group.
    Journal: Clin Chim Acta; 2006 Mar; 365(1-2):93-7. PubMed ID: 16214122.
    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.
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