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(Circulation. 2001;103:1832.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Bedside Multimarker Testing for Risk Stratification in Chest Pain Units
The Chest Pain Evaluation by Creatine Kinase-MB, Myoglobin, and Troponin I (CHECKMATE) Study
From Duke Clinical Research Institute, Durham, NC (L.K.N., A.L.K., R.H.T., S.E.M., E.M.O.); University of Cincinnati, Cincinnati, Ohio (A.B.S., W.B.G.); Carolinas Medical Center, Charlotte, NC (J.L.G.); St Luke’s Medical Center, Milwaukee, Wis (J.F.T.); and Stanford University Hospital, Palo Alto, Calif (D.H.S.).
Correspondence to L. Kristin Newby, MD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715-7969. E-mail newby001{at}mc.duke.edu
Background—Earlier, rapid evaluation in chest pain units may make patient care more efficient. A multimarker strategy (MMS) testing for several markers of myocardial necrosis with different time-to-positivity profiles also may offer clinical advantages.
Methods and Results—We prospectively compared bedside quantitative multimarker testing versus local laboratory results (LL) in 1005 patients in 6 chest pain units. Myoglobin, creatine kinase-MB, and troponin I were measured at 0, 3, 6, 9 to 12, and 16 to 24 hours after admission. Two MMS were defined: MMS-1 (all 3 markers) and MMS-2 (creatine kinase-MB and troponin I only). The primary assessment was to relate marker status with 30-day death or infarction. More patients were positive by 24 hours with MMS than with LL (MMS-1, 23.9%; MMS-2, 18.8%; LL, 8.8%; P=0.001, all comparisons), and they became positive sooner with MMS-1 (2.5 hours, P=0.023 versus LL) versus MMS-2 (2.8 hours, P=0.026 versus LL) or LL (3.4 hours). The relation between baseline MMS status and 30-day death or infarction was stronger (MMS-1: positive, 18.8% event rate versus negative, 3.0%, P=0.001; MMS-2: 21.9% versus 3.2%, P=0.001) than that for LL (13.6% versus 5.5%, P=0.038). MMS-1 discriminated 30-day death better (positive, 2.0% versus negative, 0.0%, P=0.007) than MMS-2 (positive, 1.8% versus negative, 0.2%; P=0.055) or LL (positive, 0.0% versus negative, 0.5%; P=1.000).
Conclusions—Rapid multimarker analysis identifies positive patients earlier and provides better risk stratification for mortality than a local laboratory-based, single-marker approach.
Key Words: prognosis • risk factors • angina
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|
|
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|
|
|
|
|
|
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