Comparison of troponin T versus creatine kinase-MB in suspected acute coronary syndromes

Ellen S. McErlean, Sue A. Deluca, Frederick Van Lente, Franklin Peacock IV, Jonnagadda S Rao, Craig A. Balog, Steven E. Nissen

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Limitations of creatine kinase-MB (CK-MB) have led to alternative biochemical markers, including troponin T (TnT), to detect myocardial necrosis. Limited data are available regarding the predictive value of this new marker in patients with chest pain of uncertain etiology. Therefore, we prospectively compared CK-MB and TnT in a broad population with suspected acute coronary syndromes, including those admitted to a short-stay chest pain unit. CK-MB, quantitative TnT levels, and a rapid bedside assay were performed at 0, 4, 8, and 16 hours. Adverse events, including infarction, recurrent ischemia, coronary surgery, need for catheterization and/or intervention, stroke, congestive heart failure, or death, were identified by chart review and by follow-up phone call at 6 months. Of 707 patients, 104 were excluded for creatinine >2 mg/dl or incomplete data, leaving a total cohort of 603 patients. Coronary Care Unit admissions were 18%, intermediate care admissions were 14%, telemetry admissions is 21%, and admissions to 24- hour short-stay area were 47%. TnT (at 0.1 ng/ml) and CK-MB were positive in a similar proportion of patients (20.4% and 19.7%, respectively); however, the patients identified by TnT and CK-MB were not identical. In-hospital adverse events occurred in 37.1% with no differences in positive predictive value for the markers (p = NS). If CK-MB and TnT were negative, the early adverse event rate was 27%. No cardiac marker was positive by 16 hours in 54.9% of patients with an adverse event. Six-month follow-up was obtained in 576 of the 603 patients (95.5%). One hundred fifty-five late adverse events occurred in 134 patients (23.3%) at an average of 3.3 ± 2.5 months after discharge. If both markers were negative, the late event rate was 20.2% and did not increase in patients with positive CK-MB or TnT >0.2 ng/ml. However, the late event rate was substantially higher (52.9%) in those with intermediate TnT levels of 0.1 to 0.2 ng/ml (p = 0.002). Thus, TnT is a suitable alternative to CK-MB in patients with suspected acute coronary syndromes. The rapid bedside assay is comparable to quantitative TnT and may enable early diagnosis and triage. A negative cardiac marker value (TnT or CK-MB) does not necessarily confer a low risk of complication in patients presenting with acute chest pain to an emergency department. (C) 2000 by Excerpta Medica, Inc.

Original languageEnglish
Pages (from-to)421-426
Number of pages6
JournalAmerican Journal of Cardiology
Volume85
Issue number4
DOIs
StatePublished - Feb 15 2000
Externally publishedYes

Fingerprint

MB Form Creatine Kinase
Troponin T
Acute Coronary Syndrome
Chest Pain
Coronary Care Units
Telemetry
Triage
Acute Pain
Catheterization
Infarction
Hospital Emergency Service
Early Diagnosis
Creatinine
Necrosis
Ischemia
Heart Failure
Biomarkers
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

McErlean, E. S., Deluca, S. A., Van Lente, F., Peacock IV, F., Rao, J. S., Balog, C. A., & Nissen, S. E. (2000). Comparison of troponin T versus creatine kinase-MB in suspected acute coronary syndromes. American Journal of Cardiology, 85(4), 421-426. https://doi.org/10.1016/S0002-9149(99)00766-3

Comparison of troponin T versus creatine kinase-MB in suspected acute coronary syndromes. / McErlean, Ellen S.; Deluca, Sue A.; Van Lente, Frederick; Peacock IV, Franklin; Rao, Jonnagadda S; Balog, Craig A.; Nissen, Steven E.

In: American Journal of Cardiology, Vol. 85, No. 4, 15.02.2000, p. 421-426.

Research output: Contribution to journalArticle

McErlean, ES, Deluca, SA, Van Lente, F, Peacock IV, F, Rao, JS, Balog, CA & Nissen, SE 2000, 'Comparison of troponin T versus creatine kinase-MB in suspected acute coronary syndromes', American Journal of Cardiology, vol. 85, no. 4, pp. 421-426. https://doi.org/10.1016/S0002-9149(99)00766-3
McErlean, Ellen S. ; Deluca, Sue A. ; Van Lente, Frederick ; Peacock IV, Franklin ; Rao, Jonnagadda S ; Balog, Craig A. ; Nissen, Steven E. / Comparison of troponin T versus creatine kinase-MB in suspected acute coronary syndromes. In: American Journal of Cardiology. 2000 ; Vol. 85, No. 4. pp. 421-426.
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N2 - Limitations of creatine kinase-MB (CK-MB) have led to alternative biochemical markers, including troponin T (TnT), to detect myocardial necrosis. Limited data are available regarding the predictive value of this new marker in patients with chest pain of uncertain etiology. Therefore, we prospectively compared CK-MB and TnT in a broad population with suspected acute coronary syndromes, including those admitted to a short-stay chest pain unit. CK-MB, quantitative TnT levels, and a rapid bedside assay were performed at 0, 4, 8, and 16 hours. Adverse events, including infarction, recurrent ischemia, coronary surgery, need for catheterization and/or intervention, stroke, congestive heart failure, or death, were identified by chart review and by follow-up phone call at 6 months. Of 707 patients, 104 were excluded for creatinine >2 mg/dl or incomplete data, leaving a total cohort of 603 patients. Coronary Care Unit admissions were 18%, intermediate care admissions were 14%, telemetry admissions is 21%, and admissions to 24- hour short-stay area were 47%. TnT (at 0.1 ng/ml) and CK-MB were positive in a similar proportion of patients (20.4% and 19.7%, respectively); however, the patients identified by TnT and CK-MB were not identical. In-hospital adverse events occurred in 37.1% with no differences in positive predictive value for the markers (p = NS). If CK-MB and TnT were negative, the early adverse event rate was 27%. No cardiac marker was positive by 16 hours in 54.9% of patients with an adverse event. Six-month follow-up was obtained in 576 of the 603 patients (95.5%). One hundred fifty-five late adverse events occurred in 134 patients (23.3%) at an average of 3.3 ± 2.5 months after discharge. If both markers were negative, the late event rate was 20.2% and did not increase in patients with positive CK-MB or TnT >0.2 ng/ml. However, the late event rate was substantially higher (52.9%) in those with intermediate TnT levels of 0.1 to 0.2 ng/ml (p = 0.002). Thus, TnT is a suitable alternative to CK-MB in patients with suspected acute coronary syndromes. The rapid bedside assay is comparable to quantitative TnT and may enable early diagnosis and triage. A negative cardiac marker value (TnT or CK-MB) does not necessarily confer a low risk of complication in patients presenting with acute chest pain to an emergency department. (C) 2000 by Excerpta Medica, Inc.

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