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Prediction of short-term outcome in patients with suspected myocardial infarction
P Porela1, K Pulkki, H Helenius
1Departments of Medicine, Clinical Chemistry, Biostatistics, Clinical Physiology, and Biotechnology, University of Turku, Turku, Finland.
Insights
Combining electrocardiogram (ECG) and cardiac markers like troponin I improves diagnosis of myocardial injury in acute chest pain patients. This combined approach aids risk stratification and is independent of symptom duration.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarkers
Background:
- Electrocardiogram (ECG) is crucial for acute chest pain evaluation.
- Cardiac injury markers like CK-MB and troponin I aid early patient classification.
- Combined diagnostic strategies may enhance accuracy.
Purpose of the Study:
- To evaluate the combined diagnostic and prognostic accuracy of ECG and cardiac markers in acute chest pain.
- To assess the predictive value of combined tests for myocardial injury and in-hospital mortality.
Main Methods:
- Studied 311 patients with acute chest discomfort.
- Used automated ECG interpretation.
- Assessed admission CK-MB and troponin I levels.
Main Results:
- Combined ECG and cardiac markers showed 90% sensitivity and 61% specificity for myocardial injury.
- False-negative rates were 10% and independent of symptom duration.
- Age, ECG findings, and troponin I predicted in-hospital mortality.
Conclusions:
- Biochemical markers and ECG criteria enable risk stratification for acute ischemic events.
- Automated data analysis is feasible and unaffected by patient delay.
Study Objective:
Although specific cardiac injury markers have enhanced early patient classification, the ECG remains a necessary investigation in the acute phase of chest pain. Combined use of both tests could further improve the diagnostic and prognostic accuracy.
Methods:
We studied 311 consecutive patients who came to the emergency department of a regional referral hospital for the differential diagnosis of acute chest discomfort. The admission ECG was classified using an automated interpretation program and tested together with elevated admission creatine kinase isoform MB (CK-MB) and cardiac troponin I (TnI) concentration for prediction of final myocardial injury (44%) and in-hospital mortality (14%).
Results:
Combining the information from the admission ECG and cardiac markers, the sensitivity for becoming final myocardial injury (maximal CK-MB >/=11 microg/L) was 90% and specificity 61%. The proportion of false-negative results (10%) was independent of symptom duration. Age, positive ECG findings, and increased admission TnI levels were predictive for in-hospital mortality.
Conclusion:
The commonly available biochemical and ECG criteria allow risk stratification of patients with a suspected acute ischemic event. The data analysis can easily be automated and is independent of patient delay.