(Circulation. 2000;102:1107.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Prospective Study Correlating Fibrinopeptide A, Troponin I, Myoglobin, and Myosin Light Chain Levels With Early and Late Ischemic Events in Consecutive Patients Presenting to the Emergency Department With Chest Pain
Presented in part at the Annual Scientific Sessions of the American College of Cardiology (Anaheim, Calif, March 16–19, 1997 and Atlanta, Ga, March 29–April 12, 1998) and European Society of Cardiology (Barcelona, Spain, August 28–September 1, 1999) and published in abstract form (J Am Coll Cardiol. 1997;29:131A, J Am Coll Cardiol. 1998;31:91A, and Eur Heart J. 1999;20(suppl):594).
From the University of Pennsylvania (B.M.S., R.L.W.), University of Pittsburgh, and the Pittsburgh VA Health System (A.S.), Pittsburgh, Pa, and Indiana University Medical Center, Indianapolis, Ind (N.F., N.B.).
Correspondence to Robert L. Wilensky, MD, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. E-mail rwilensk{at}mail.med.upenn.edu
Background—Although thrombus formation plays a major role in acute coronary syndromes, few studies have evaluated a thrombus marker in risk stratification of patients with chest pain. Furthermore, the relation between markers that reflect myocardial injury and thrombus formation that may predict events in a heterogeneous patient population is unknown. This study correlated markers of thrombus and myocardial injury with early and late ischemic events in consecutive patients with chest pain.
Methods and Results—Serum troponin I (TnI), myoglobin, and myosin light chain levels were obtained from 247 patients and urinary fibrinopeptide A (FPA) from 178 of the 247. By multivariate analysis, patients with an elevated FPA level were 4.82 times more likely to die or have myocardial infarction, unstable angina, and coronary revascularization at 1 week (P=0.002, 95% CI 1.78, 13.03), whereas those with an elevated TnI (>0.2 ng/mL) were 9.41 times more likely (P<0.001, 95% CI 2.84, 31.17). At 6 months (excluding the index event), an elevated FPA level was an independent predictor of events, with an odds ratio of 9.57 (P<0.001, C1 3.29, 27.8), and was the only marker to predict a shorter event-free survival (P<0.001). The other markers did not independently correlate with cardiac events, although MLC incrementally increased early predictive accuracy in combination with the FPA and TnI.
Conclusions—Elevated FPA and TnI correlated with cardiac events during the initial week in patients presenting to the Emergency Department with chest pain. FPA predicted adverse events and a shorter event-free survival at 6 months.
Key Words: myoglobin • myosin light chain • ischemia
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