Three cardiac markers allow rapid, accurate triage of chest pain patients


WESTPORT, CT (Reuters Health) – An accelerated critical pathway for chest pain evaluation in the emergency department, including assessment of cardiac troponin I (cTnI), creatine kinase-MB (CK-MB) and myoglobin levels, can identify 100% of MIs within 90 minutes, according to a report in The American Journal of Cardiology for September 15.

"Many hospitals use only one marker, and they don't get results back for up to 2 hours," Dr. Alan S. Maisel from the Veterans Administration San Diego Health Care System, California, said in a hospital statement.

"We use rapid point-of-care testing of three markers done three to four times over 90 minutes. We think this is the most accurate method to-date for rapidly triaging both high- and low-risk heart patients," he added.

Dr. Maisel and colleagues performed an observational study of 1285 consecutive patients with signs and symptoms of cardiac ischemia who were evaluated using clinical history, ECG findings and triple cardiac markers.

Myocardial infarction (MI) was diagnosed if any or all markers were positive and ruled out only if all markers were negative. Using this protocol, all MI patients were identified within 90 minutes, Dr. Maisel's group reports. Specificity was 94%.

Ninety percent of the patients with negative cardiac markers and negative electrocardiograms were discharged, the researchers note. CCU admissions were reduced by 40%.

"This pathway, which uses high-risk features from patients' history and electrocardiogram along with rapid, point-of-care testing of a panel of myocardial markers, has the advantage of being simple to follow, inexpensive and available to any emergency department or urgent care clinic," Dr. Maisel and colleagues stress.

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