The utility of four biochemical markers in the triage of chest pain patients.

M H Ellestad, R Startt-Selvester, E Stanton, B VanNatta, J Ahmad, Y Gawad, F Swiger

Journal: Cardiology 2000;93(4):242-8

PMID: 11025350

Full Text on S. Karger AG, Basel, Switzerland View on PubMed

Abstract

Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.

Address: Memorial Heart Institute, Long Beach, CA 90801-1428, USA.

DOI: 10.1159/000007033

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https://medlineplus.gov/chestpain.html

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https://assays.cancer.gov/CPTAC-323

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MeSH Terms: Aged, Angina, Unstable, Biomarkers, Chest Pain, Creatine Kinase, Creatine Kinase, MB Form, Diagnosis, Differential, Electrocardiography, Enzyme-Linked Immunosorbent Assay, Female, Humans, Isoenzymes, Male, Middle Aged, Myocardial Infarction, Myoglobin, Myosin Light Chains, Prospective Studies, Severity of Illness Index, Triage, Troponin I