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Comparison between strategies using creatine kinase-MB(mass), myoglobin, and troponin T in the early detection or exclusion of acute myocardial infarction in patients with chest pain and a nondiagnostic electrocardiogra

      The evaluation of patients with symptoms suggestive of an acute myocardial infarction (AMI) and a nondiagnostic electrocardiogram is a difficult clinical task. During the past decade, test systems for the more sensitive and specific myocardial markers, creatine kinase (CK-MB[mass]), troponin T, and myoglobin have been developed, making it possible to shorten the time needed for detection or exclusion of AMI.
      • Gibler W.B
      • Lewis L.M
      • Erb R.E
      • Makens P.K
      • Kaplan B.C
      • Vaughn R.H
      • Biagini A.V
      • Blanton J.D
      • Campbell W.B
      Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECG serial CK-MB sampling in the emergency department.
      ,
      • Collinson P.O
      • Rosalki S.B
      • Kuwana T
      • Garratt H.M
      • Ramhamadamy E.M
      • Baird I.M
      • Greenwood T.W
      Early diagnosis of acute myocardial infarction by CK-MB mass measurements.
      ,
      • Ohman E.M
      • Casey C
      • Bengtson J.R
      • Pryor D
      • Tormey W
      • Horgan J.H
      Early detection of acute myocardial infarction additional diagnostic information from serum concentrations of myoglobin in patients without ST-elevation.
      ,
      • Mair J
      • Artner-Dworzak E
      • Lechleitner P
      • Smidt J
      • Wagner I
      • Dienstl F
      • Puschendorf B
      Cardiac troponin T in diagnosis of acute myocardial infarction.
      In addition to the evaluation of each marker separately using a predefined decision limit, other marker strategies have been suggested.
      • Mair J
      • Artner-Dworzak E
      • Lechleitner P
      • Smidt J
      • Wagner I
      • Dienstl F
      • Puschendorf B
      Cardiac troponin T in diagnosis of acute myocardial infarction.
      ,
      • Bhayana V
      • Cohoe S
      • Pellar T.G
      • Jablonsky G
      • Henderson A.R
      Combination (multiple) testing for myocardial infarction using myoglobin, creatine kinase-2 (mass), and troponin T.
      ,
      • Lindahl B
      • Venge P
      • Wallentin L
      Early diagnosis and exclusion of acute myocardial infarction using biochemical monitoring.
      ,
      • Brogan G.X
      • Friedman S
      • McCuskey C
      • Cooling D.S
      • Berrutti L
      • Thode H.C
      • Bock J.L
      Evaluation of a new rapid quantitative immunoassay for serum myoglobin versus CK-MB for ruling out acute myocardial infarction in the emergency department.
      ,
      • Kontos M.C
      • Anderson F.P
      • Schmidt K.A
      • Ornato J.P
      • Tatum J.L
      • Jesse R.L
      Early diagnosis of acute myocardial infarction in patients without ST-segment elevation.
      ,
      • De Winter R.J
      • Koster R.W
      • Van Straalen J.P
      • Gorgels J.P.M.C
      • Hoek F
      • Sanders G.T
      Critical difference between serial measurements of CK-MB mass to detect myocardial damage.
      However, most previous studies evaluating these new markers have been hampered by either small sample sizes or inclusion of patients with ST elevation. The aims of the present study were therefore to compare the early diagnostic performance of these new biochemical markers and to evaluate different marker strategies in a large sample of patients with chest pain and a nondiagnostic electrocardiogram.
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      References

        • Gibler W.B
        • Lewis L.M
        • Erb R.E
        • Makens P.K
        • Kaplan B.C
        • Vaughn R.H
        • Biagini A.V
        • Blanton J.D
        • Campbell W.B
        Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECG.
        Ann Emerg Med. 1990; 19: 1359-1366
        • Collinson P.O
        • Rosalki S.B
        • Kuwana T
        • Garratt H.M
        • Ramhamadamy E.M
        • Baird I.M
        • Greenwood T.W
        Early diagnosis of acute myocardial infarction by CK-MB mass measurements.
        Ann Clin Biochem. 1992; 29: 43-47
        • Ohman E.M
        • Casey C
        • Bengtson J.R
        • Pryor D
        • Tormey W
        • Horgan J.H
        Early detection of acute myocardial infarction.
        Br Heart J. 1990; : 335-338
        • Mair J
        • Artner-Dworzak E
        • Lechleitner P
        • Smidt J
        • Wagner I
        • Dienstl F
        • Puschendorf B
        Cardiac troponin T in diagnosis of acute myocardial infarction.
        Clin Chem. 1991; 37: 845-852
        • Bhayana V
        • Cohoe S
        • Pellar T.G
        • Jablonsky G
        • Henderson A.R
        Combination (multiple) testing for myocardial infarction using myoglobin, creatine kinase-2 (mass), and troponin T.
        Clin Biochem. 1994; 27: 395-406
        • Lindahl B
        • Venge P
        • Wallentin L
        Early diagnosis and exclusion of acute myocardial infarction using biochemical monitoring.
        Coron Artery Disease. 1995; 6: 321-328
        • Brogan G.X
        • Friedman S
        • McCuskey C
        • Cooling D.S
        • Berrutti L
        • Thode H.C
        • Bock J.L
        Evaluation of a new rapid quantitative immunoassay for serum myoglobin versus CK-MB for ruling out acute myocardial infarction in the emergency department.
        Ann Emerg Med. 1994; 24: 665-671
        • Kontos M.C
        • Anderson F.P
        • Schmidt K.A
        • Ornato J.P
        • Tatum J.L
        • Jesse R.L
        Early diagnosis of acute myocardial infarction in patients without ST-segment elevation.
        Am J Cardiol. 1999; 83: 155-158
        • De Winter R.J
        • Koster R.W
        • Van Straalen J.P
        • Gorgels J.P.M.C
        • Hoek F
        • Sanders G.T
        Critical difference between serial measurements of CK-MB mass to detect myocardial damage.
        Clin Chem. 1997; 43: 338-343
        • Fraser C.G
        • Harris E.K
        Generation and application of data on biological variation in Clinical chemistry.
        Crit Rev Clin Lab Sci. 1989; 27: 409-437
        • Ross S.M
        • Fraser C.G
        Biological variation of cardiac markers.
        Ann Clin Biochem. 1998; 35: 80-84
        • Adams J.E
        • Abendschein D.R
        • Jaffe A.S
        Biochemical markers of myocardial injury—is MB creatine kinase the choice for the 1990s?.
        Circulation. 1993; 88: 750-763
        • De Winter R.J
        • Koster R.W
        • Sturk A
        • Sanders G.T
        Value of myoglobin, troponin T, and CK-MB mass in ruling out an acute myocardial infarction in the emergency room.
        Circulation. 1995; 92: 3401-3407
        • Tucker J.F
        • Collins R.A
        • Anderson A.J
        • Hauser J
        • Kalas J
        • Apple F.S
        Early diagnostic efficiency of cardiac troponin I and troponin T for acute myocardial infarction.
        Acad Emerg Med. 1997; 4: 13-21
        • Zimmerman J
        • Fromm R
        • Meyer D
        • Boudreaux A
        • Wun C.C
        • Smalling R
        • Davis R
        • Habib G
        • Roberts R
        Diagnostic markers cooperative study for the diagnosis of myocardial infarction.
        Circulation. 1999; 99: 1671-1677
        • Panteghini M
        • Apple F.S
        • Christenson R.H
        • Dati F
        • Mair J
        • Wu A.H
        Proposals from IFCC committee on standardization of markers of cardiac damage (C-SMCD).
        Scan J Clin Lab Invest. 1999; 59: 103-112
        • Hamm C.W
        • Goldmann B.U
        • Heeschen C
        • Kreymann G
        • Berger J
        • Meinertz T
        Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I.
        N Engl J Med. 1997; 337: 1648-1653