Usefulness of myocardial necrosis triad markers for predicting 4-year mortality in patients with suspected acute coronary syndrome.

摘要

OBJECTIVE: Cardiac troponins (cTn), creatine kinase-MB (CK-MB), myoglobin (MYO) are commonly used biochemical markers for risk stratification and diagnosis in patients with suspected acute coronary syndrome (ACS). The aim of the study was to analyse the prognostic implications of 3 myocardial necrosis markers measured at admission in the long-term observation. METHODS: The study group consisted of 336 consecutive patients whose concentration of cTnl, CK-MB and MYO were measured at admission. Patients were categorized into 4 groups according to the number of positive myocardial necrosis markers. RESULTS: There was a significant increase in the mean marker levels with increasing numbers of positive markers (over upper normal range): cTnl (0.02 +/- 0.06; 0.7 +/- 1.9; 3.4 +/- 8.8; 5.1 +/- 9.2 ng/ml; P < 0.001), CK-MB (1.3 +/- 1.1; 3.3 +/- 3.9; 21.9 +/- 39.4; 37.5 +/- 48.4 ng/ml; P < 0.001), MYO (39.4 +/- 16.5; 94.5 +/- 91; 202.2 +/- 172.2; 320.3 +/- 234.3 ng/ml; P < 0.001). There was a statistically significant increase in the 4-year all-cause mortality with increasing numbers of positive markers; P value for trend < 0.0001. CONCLUSIONS: All 3 marker levels at admission may be an important addition to the risk stratification of patients with suspected ACS and a potentially important target for therapy. They have prognostic implications in the long-term observation of patients with chest pain and suspected ACS.