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(Circulation. 1999;99:1671-1677.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Diagnostic Marker Cooperative Study for the Diagnosis of Myocardial Infarction
From General Medicine (J.Z.) and Section of Cardiology (R.F., D.M., G.H., R.R.), Baylor College of Medicine, Houston, Tex, and Section of Cardiology (A.B., R.S.) and School of Public Health (C.-C.C.W., B.D.), University of Texas Health Science Center, Houston, Tex.
Background—Millions of patients present annually with chest pain, but only 10% to 15% have myocardial infarction. Lack of diagnostic sensitivity and specificity of clinical and conventional markers prevents or delays treatment and leads to unnecessary costly admissions. Comparative data are lacking on the new markers, yet using all of them is inappropriate and expensive.
Methods and Results—The Diagnostic Marker Cooperative
Study was a prospective, multicenter, double-blind study with
consecutive enrollment of patients with chest pain presenting to
the emergency department. Diagnostic sensitivity and
specificity and frequency of increase in patients with unstable angina
were determined for creatine kinase-MB (CK-MB) subforms, myoglobin,
total CK-MB (activity and mass), and troponin T and I on the basis of
frequent serial sampling for 
24 hours. Of 955 patients with chest
pain, 119 (12.5%) had infarction identified by use of CK-MB mass, and
203 (21%) had unstable angina. CK-MB subforms were most sensitive and
specific (91% and 89%) within 6 hours of onset, followed by myoglobin
(78% and 89%). For late diagnosis, total CK-MB activity (derived from
subforms) was the most sensitive and specific (96% and 98%) at 10
hours from onset, followed by troponin I (96% and 93%), but not until
18 hours, and troponin T (87% and 93% at 10 hours). In unstable
angina, CK-MB subforms were increased in 29.5%, myoglobin in 23.7%,
troponin I in 19.7%, and troponin T in 14.8%. All markers were
increased in 99 patients. With each marker as the
diagnostic standard, CK-MB subforms and myoglobin remained
the most sensitive for early diagnosis.
Conclusions—The CK-MB subform assay alone or in combination with a troponin reliably triages patients with chest pain and should lead to improved therapy and reduced cost.
Key Words: creatine kinase • troponin T • tropinin I • myoglobin • myocardial infarction
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