PMID- 10905641
OWN - NLM
STAT- MEDLINE
DCOM- 20001113
LR  - 20190910
IS  - 1069-6563 (Print)
IS  - 1069-6563 (Linking)
VI  - 7
IP  - 6
DP  - 2000 Jun
TI  - Myoglobin for early risk stratification of emergency department patients with 
      possible myocardial ischemia.
PG  - 625-36
AB  - OBJECTIVES: To determine and compare the prognostic abilities of early, 
      single-sample myoglobin measurement with that of creatine kinase-MB (CK-MB), with 
      cardiac troponin T (cTnT), and with physician judgment in the absence of marker 
      results among emergency department (ED) patients with possible myocardial 
      ischemia. METHODS: Prospective collection of clinical and serologic data using an 
      identity-unlinked technique from patients with possible myocardial ischemia at 
      two urban EDs. Outcome data concerning the occurrence of adverse events (AEs) 
      during the 14 days after enrollment were used to calculate and compare the 
      relative risks (RRs) and predictive values (with 95% confidence intervals) of the 
      various markers for predicting AEs. RESULTS: Among 396 analyzed patients, 65 
      (16.4%) accrued 104 AEs, including 13 deaths (3.3%) and 31 (7.8%) myocardial 
      infarctions. Myoglobin predicted AEs (RR = 3.36 [95% CI = 2.19 to 5.15]) with 
      significantly higher sensitivity (50.8% [95% CI = 38.6 to 62.9]) than either 
      CK-MB (15.4% [95% CI = 6.6 to 24.2]) or cTnT (24.6% [95% CI = 14.1 to 35.1]), but 
      with lower specificity (81.9% [95% CI = 77.7 to 86.0]; CK-MB = 99.7% [95% CI = 
      99.1 to 100]; cTnT = 93.1% [95% CI = 90.3 to 95.8]). Myoglobin had prognostic 
      ability among patients with chest pain (3.86 [95% CI = 2.39 to 6.22]) and 
      atypical (non-chest pain) presentations (2.71 [95% CI = 1.09 to 6.71]), including 
      those with a nondiagnostic electrocardiogram (3.11 [95% CI = 1.44 to 6.69]). The 
      combination of myoglobin and physician decision making identified 63 of the 65 
      patients (96.9% [95% CI = 92.7 to 100]) with subsequent AEs. CONCLUSIONS: The 
      early prognostic sensitivity of myoglobin may allow identification of some 
      high-risk patients missed by physician judgment, CK-MB, and cTnT. Myoglobin 
      should be considered for use in the ED based on both its diagnostic and 
      prognostic abilities.
FAU - Green, G B
AU  - Green GB
AD  - Department of Emergency Medicine, The Johns Hopkins University School of 
      Medicine, Baltimore, MD 21287-2080, USA. ggreen@jhmi.edu
FAU - Skarbek-Borowski, G W
AU  - Skarbek-Borowski GW
FAU - Chan, D W
AU  - Chan DW
FAU - Kelen, G D
AU  - Kelen GD
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
RN  - 0 (Biomarkers)
RN  - 0 (Isoenzymes)
RN  - 0 (Myoglobin)
RN  - 0 (Troponin T)
RN  - EC 2.7.3.2 (Creatine Kinase)
SB  - IM
MH  - Adult
MH  - Biomarkers/analysis
MH  - Confidence Intervals
MH  - Creatine Kinase/*blood
MH  - Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Isoenzymes/blood
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/*blood/*diagnosis/enzymology
MH  - Myoglobin/*blood
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Sensitivity and Specificity
MH  - Severity of Illness Index
MH  - Troponin T/*blood
EDAT- 2000/07/25 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/07/25 11:00
PHST- 2000/07/25 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/07/25 11:00 [entrez]
AID - 10.1111/j.1553-2712.2000.tb02035.x [doi]
PST - ppublish
SO  - Acad Emerg Med. 2000 Jun;7(6):625-36. doi: 10.1111/j.1553-2712.2000.tb02035.x.