Key result
Early myoglobin measurement predicted 14-day adverse events (RR 3.36; 95% CI 2.19-5.15) with higher sensitivity but lower specificity than CK-MB or cTnT in patients with possible myocardial ischemia.
Why the study?
Does early, single-sample myoglobin measurement improve prediction of adverse events in emergency department patients with possible myocardial ischemia compared to CK-MB, cTnT, and physician judgment?
Observational (n=396)
Yes
Does early, single-sample myoglobin measurement improve prediction of adverse events in emergency department patients with possible myocardial ischemia compared to CK-MB, cTnT, and physician judgment?
Relative Risk: 3.36 (95% CI 2.19–5.15)
Early myoglobin measurement offers higher sensitivity but lower specificity than CK-MB and cTnT for predicting 14-day adverse events in ED patients with possible myocardial ischemia.
Early myoglobin may aid identification of high-risk ED ischemia patients missed by other markers; leaves open need for outcome trials before adoption.
OBJECTIVES: To determine and compare the prognostic abilities of early, single-sample myoglobin measurement with that of creatine kinase-MB (CK-MB), with cardiac troponin T (cTnT), and with physician judgment in the absence of marker results among emergency department (ED) patients with possible myocardial ischemia. METHODS: Prospective collection of clinical and serologic data using an identity-unlinked technique from patients with possible myocardial ischemia at two urban EDs. Outcome data concerning the occurrence of adverse events (AEs) during the 14 days after enrollment were used to calculate and compare the relative risks (RRs) and predictive values (with 95% confidence intervals) of the various markers for predicting AEs. RESULTS: Among 396 analyzed patients, 65 (16.4%) accrued 104 AEs, including 13 deaths (3.3%) and 31 (7.8%) myocardial infarctions. Myoglobin predicted AEs (RR = 3.36 [95% CI = 2.19 to 5.15]) with significantly higher sensitivity (50.8% [95% CI = 38.6 to 62.9]) than either CK-MB (15.4% [95% CI = 6.6 to 24.2]) or cTnT (24.6% [95% CI = 14.1 to 35.1]), but with lower specificity (81.9% [95% CI = 77.7 to 86.0]; CK-MB = 99.7% [95% CI = 99.1 to 100]; cTnT = 93.1% [95% CI = 90.3 to 95.8]). Myoglobin had prognostic ability among patients with chest pain (3.86 [95% CI = 2.39 to 6.22]) and atypical (non-chest pain) presentations (2.71 [95% CI = 1.09 to 6.71]), including those with a nondiagnostic electrocardiogram (3.11 [95% CI = 1.44 to 6.69]). The combination of myoglobin and physician decision making identified 63 of the 65 patients (96.9% [95% CI = 92.7 to 100]) with subsequent AEs. CONCLUSIONS: The early prognostic sensitivity of myoglobin may allow identification of some high-risk patients missed by physician judgment, CK-MB, and cTnT. Myoglobin should be considered for use in the ED based on both its diagnostic and prognostic abilities.
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Green et al. (2000) conducted an observational in possible myocardial ischemia (n=396). Early myoglobin measurement vs. CK-MB, cTnT, and physician judgment was evaluated on Adverse events (AEs) during the 14 days after enrollment (RR 3.36, 95% CI 2.19 to 5.15). Early myoglobin measurement predicted 14-day adverse events (RR 3.36; 95% CI 2.19-5.15) with higher sensitivity but lower specificity than CK-MB or cTnT in patients with possible myocardial ischemia.
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