A strategy for the use of cardiac injury markers (troponin I and T, creatine kinase-MB mass and isoforms, and myoglobin) in the diagnosis of acute myocardial infarction

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Abstract

Objective. - To design a strategy for cardiac injury marker testing in the diagnosis of acute myocardial infarction. Design. - Prospective study. Group I (n = 54 patients): evaluation of clinical performance. Specimens collected at 0, 3, 6, and 12 (± 1.5) hours after presentation. World Health Organization criteria were used for diagnosis of acute myocardial infarction. Group II (n = 57 patients): evaluation of temporal evolution. Time intervals 0 to 1.5, 1.5 to 4.5, 4.5 to 7.5, and 7.5 to 13.5 hours. Patients identified by positive creatine kinase-MB (CK-MB) mass or myoglobin. Fourteen patients in Group I qualified for Group II. Hence, the total number of patients was 97. Setting. - A team of laboratorians and clinicians at the University of California, Davis, hospital assessed the clinical performance and temporal evolution of serial CK-MB isoform, troponin I, and troponin T results in comparison to parallel CK-MB mass and myoglobin results. Main Outcome Measures. - Group I: sensitivity, specificity, and positive and negative predictive values. Group II: the time interval of the first positive result for each cardiac injury marker. Strategy and conclusions were based on study results and a literature review. Participants. - Emergency department patients with acute onset of chest pain and other complaints, possibly indicative of myocardial ischemia, who were under evaluation for admission. Results. - Twenty-seven cases of acute myocardial infarction were documented. Group I: troponin I had the highest specificity (100%) and the highest positive predictive value (100%); troponin I, troponin T, and CK-MB mass had the highest sensitivity (90.0%); and the negative predictive values of troponin I, troponin T, and CK-MB mass were comparable (97.8%, 97.6%, and 97.6%, respectively). Group II: early diagnosis (within 1.5 hours) was provided by both CK-MB isoforms and CK-MB mass, and then by myoglobin and troponins, in order of decreasing frequency. Conclusions. - Creatinine kinase-MB mass, myoglobin and troponin I were selected as the cardiac injury markers of choice at our institution of myoglobin and CK-MB mass initially - and serially if warranted by heightened clinical suspicion - with troponin I added if indicated for (1) specific confirmation, (2) late presentation, or (3) risk stratification.

Original languageEnglish (US)
Pages (from-to)245-251
Number of pages7
JournalArchives of Pathology and Laboratory Medicine
Volume122
Issue number3
StatePublished - Mar 1998

Fingerprint

MB Form Creatine Kinase
Troponin T
Troponin I
Myoglobin
Protein Isoforms
Myocardial Infarction
Wounds and Injuries
Troponin
Chest Pain
Myocardial Ischemia
Hospital Emergency Service
Early Diagnosis
Creatinine
Phosphotransferases
Outcome Assessment (Health Care)
Prospective Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Medical Laboratory Technology

Cite this

@article{aaa0f73ed8ff435abf8eee37d826e64a,
title = "A strategy for the use of cardiac injury markers (troponin I and T, creatine kinase-MB mass and isoforms, and myoglobin) in the diagnosis of acute myocardial infarction",
abstract = "Objective. - To design a strategy for cardiac injury marker testing in the diagnosis of acute myocardial infarction. Design. - Prospective study. Group I (n = 54 patients): evaluation of clinical performance. Specimens collected at 0, 3, 6, and 12 (± 1.5) hours after presentation. World Health Organization criteria were used for diagnosis of acute myocardial infarction. Group II (n = 57 patients): evaluation of temporal evolution. Time intervals 0 to 1.5, 1.5 to 4.5, 4.5 to 7.5, and 7.5 to 13.5 hours. Patients identified by positive creatine kinase-MB (CK-MB) mass or myoglobin. Fourteen patients in Group I qualified for Group II. Hence, the total number of patients was 97. Setting. - A team of laboratorians and clinicians at the University of California, Davis, hospital assessed the clinical performance and temporal evolution of serial CK-MB isoform, troponin I, and troponin T results in comparison to parallel CK-MB mass and myoglobin results. Main Outcome Measures. - Group I: sensitivity, specificity, and positive and negative predictive values. Group II: the time interval of the first positive result for each cardiac injury marker. Strategy and conclusions were based on study results and a literature review. Participants. - Emergency department patients with acute onset of chest pain and other complaints, possibly indicative of myocardial ischemia, who were under evaluation for admission. Results. - Twenty-seven cases of acute myocardial infarction were documented. Group I: troponin I had the highest specificity (100{\%}) and the highest positive predictive value (100{\%}); troponin I, troponin T, and CK-MB mass had the highest sensitivity (90.0{\%}); and the negative predictive values of troponin I, troponin T, and CK-MB mass were comparable (97.8{\%}, 97.6{\%}, and 97.6{\%}, respectively). Group II: early diagnosis (within 1.5 hours) was provided by both CK-MB isoforms and CK-MB mass, and then by myoglobin and troponins, in order of decreasing frequency. Conclusions. - Creatinine kinase-MB mass, myoglobin and troponin I were selected as the cardiac injury markers of choice at our institution of myoglobin and CK-MB mass initially - and serially if warranted by heightened clinical suspicion - with troponin I added if indicated for (1) specific confirmation, (2) late presentation, or (3) risk stratification.",
author = "Kost, {Gerald J} and Kirk, {James D} and Kathy Omand",
year = "1998",
month = "3",
language = "English (US)",
volume = "122",
pages = "245--251",
journal = "Archives of Pathology and Laboratory Medicine",
issn = "0003-9985",
publisher = "College of American Pathologists",
number = "3",

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TY - JOUR

T1 - A strategy for the use of cardiac injury markers (troponin I and T, creatine kinase-MB mass and isoforms, and myoglobin) in the diagnosis of acute myocardial infarction

AU - Kost, Gerald J

AU - Kirk, James D

AU - Omand, Kathy

PY - 1998/3

Y1 - 1998/3

N2 - Objective. - To design a strategy for cardiac injury marker testing in the diagnosis of acute myocardial infarction. Design. - Prospective study. Group I (n = 54 patients): evaluation of clinical performance. Specimens collected at 0, 3, 6, and 12 (± 1.5) hours after presentation. World Health Organization criteria were used for diagnosis of acute myocardial infarction. Group II (n = 57 patients): evaluation of temporal evolution. Time intervals 0 to 1.5, 1.5 to 4.5, 4.5 to 7.5, and 7.5 to 13.5 hours. Patients identified by positive creatine kinase-MB (CK-MB) mass or myoglobin. Fourteen patients in Group I qualified for Group II. Hence, the total number of patients was 97. Setting. - A team of laboratorians and clinicians at the University of California, Davis, hospital assessed the clinical performance and temporal evolution of serial CK-MB isoform, troponin I, and troponin T results in comparison to parallel CK-MB mass and myoglobin results. Main Outcome Measures. - Group I: sensitivity, specificity, and positive and negative predictive values. Group II: the time interval of the first positive result for each cardiac injury marker. Strategy and conclusions were based on study results and a literature review. Participants. - Emergency department patients with acute onset of chest pain and other complaints, possibly indicative of myocardial ischemia, who were under evaluation for admission. Results. - Twenty-seven cases of acute myocardial infarction were documented. Group I: troponin I had the highest specificity (100%) and the highest positive predictive value (100%); troponin I, troponin T, and CK-MB mass had the highest sensitivity (90.0%); and the negative predictive values of troponin I, troponin T, and CK-MB mass were comparable (97.8%, 97.6%, and 97.6%, respectively). Group II: early diagnosis (within 1.5 hours) was provided by both CK-MB isoforms and CK-MB mass, and then by myoglobin and troponins, in order of decreasing frequency. Conclusions. - Creatinine kinase-MB mass, myoglobin and troponin I were selected as the cardiac injury markers of choice at our institution of myoglobin and CK-MB mass initially - and serially if warranted by heightened clinical suspicion - with troponin I added if indicated for (1) specific confirmation, (2) late presentation, or (3) risk stratification.

AB - Objective. - To design a strategy for cardiac injury marker testing in the diagnosis of acute myocardial infarction. Design. - Prospective study. Group I (n = 54 patients): evaluation of clinical performance. Specimens collected at 0, 3, 6, and 12 (± 1.5) hours after presentation. World Health Organization criteria were used for diagnosis of acute myocardial infarction. Group II (n = 57 patients): evaluation of temporal evolution. Time intervals 0 to 1.5, 1.5 to 4.5, 4.5 to 7.5, and 7.5 to 13.5 hours. Patients identified by positive creatine kinase-MB (CK-MB) mass or myoglobin. Fourteen patients in Group I qualified for Group II. Hence, the total number of patients was 97. Setting. - A team of laboratorians and clinicians at the University of California, Davis, hospital assessed the clinical performance and temporal evolution of serial CK-MB isoform, troponin I, and troponin T results in comparison to parallel CK-MB mass and myoglobin results. Main Outcome Measures. - Group I: sensitivity, specificity, and positive and negative predictive values. Group II: the time interval of the first positive result for each cardiac injury marker. Strategy and conclusions were based on study results and a literature review. Participants. - Emergency department patients with acute onset of chest pain and other complaints, possibly indicative of myocardial ischemia, who were under evaluation for admission. Results. - Twenty-seven cases of acute myocardial infarction were documented. Group I: troponin I had the highest specificity (100%) and the highest positive predictive value (100%); troponin I, troponin T, and CK-MB mass had the highest sensitivity (90.0%); and the negative predictive values of troponin I, troponin T, and CK-MB mass were comparable (97.8%, 97.6%, and 97.6%, respectively). Group II: early diagnosis (within 1.5 hours) was provided by both CK-MB isoforms and CK-MB mass, and then by myoglobin and troponins, in order of decreasing frequency. Conclusions. - Creatinine kinase-MB mass, myoglobin and troponin I were selected as the cardiac injury markers of choice at our institution of myoglobin and CK-MB mass initially - and serially if warranted by heightened clinical suspicion - with troponin I added if indicated for (1) specific confirmation, (2) late presentation, or (3) risk stratification.

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