Key result
Positive results on cardiac diagnostic markers (except myoglobin) predicted the composite endpoint of death or revascularization at 6 months in patients presenting with chest pain (p<0.05).
Why the study?
Do cardiac diagnostic markers (CK-MB, troponins, myoglobin) predict short- and long-term clinical events in patients presenting with chest pain?
RCT (n=955)
Double-blind
Yes
Do cardiac diagnostic markers (CK-MB, troponins, myoglobin) predict short- and long-term clinical events in patients presenting with chest pain?
p-value: p=<0.05
Cardiac diagnostic markers, particularly CK-MB subforms and troponins, provide significant prognostic value for predicting death or revascularization at 6 months in patients presenting with chest pain.
Marker data refine 30-day/6-month risk stratification after chest pain; extends diagnostic findings to outcomes in emergency cohorts.
BACKGROUND: Millions of patients present annually with chest pain, but only 10% have myocardial infarction (MI). We recently reported comparative sensitivity and specificity of available markers in the diagnosis of MI; however, optimum interpretation of marker results requires prognostic follow-up data. HYPOTHESIS: The study was undertaken to study the accuracy of CK-MB subforms, troponin I and T, myoglobin, and CK-MB in predicting clinical events at 30 days and 6 months. METHODS: In all, 955 consecutive patients with chest pain were enrolled in a prospective, multicenter, double-blind study to test the prognostic accuracy of these markers. RESULTS: Myocardial infarction was diagnosed in 119 by CK-MB mass criteria and unstable angina (UA) in 203 patients by clinical criteria. Follow-up at 30 days and 6 months was available in 824 and 724 patients, respectively, with mortalities of 2.8 and 4.14%, respectively. Cumulative 6-month mortality was 5.6% in MI, 4.4% in UA, and 3.0% in others. Revascularization was reported in 9.3% of patients by 6 months. A positive test on each of the markers except myoglobin was predictive of revascularization. The composite endpoint of death or revascularization occurred in 107 patients by 6 months and a positive result on each of the markers was predictive of this composite endpoint (p < 0.05). The relative risk of death or revascularization for patients who did not have MI but tested positive on each of the markers was > 1.0 but did not reach statistical significance. CONCLUSIONS: With the possible exception of myoglobin, each of the diagnostic markers displayed similar prognostic performance in patients with chest pain presenting to emergency departments. The most appropriate markers to triage patients with chest pain, which has both adequate early diagnostic sensitivity and prognostic accuracy, are the CK-MB subforms.
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Fromm et al. (2001) conducted an RCT in chest pain (n=955). Positive cardiac diagnostic markers (CK-MB subforms, troponin I and T, CK-MB) vs. Negative test was evaluated on composite endpoint of death or revascularization by 6 months (p=<0.05). Positive results on cardiac diagnostic markers (except myoglobin) predicted the composite endpoint of death or revascularization at 6 months in patients presenting with chest pain (p<0.05).
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