972-104 Diagnostic Ability of a Single Admission Value of Serum Myoglobin, Troponin-T and CK-MB in Acute Myocardial Infarction Patients

Admission serum myoglobin 1Mb) and troponin-T(TNT) levels were evaluated vs admission CK-MB (mass assay) levels and the admission ECG ST elevation (ST↑)>2 m V. for their diagnostic values in patients with suspected acute myocardial infarction (AMI) before thrombolytic treatment.Consecutive patients (n=153), presenting with chest pain at rest>30 min but<12 hrs, unresponsive to nitroglycerin, were included. The ultimate diagnosis of AMI was based on a rise and fall pattern of CK-MB (catalytic assay) and a peak value>15 U/I, and/or the development of Q-waves on the ECG.AMI (n = 81) (median (95% C))No-AMI(n = 72) (median (95% C))pminutes to admission179,6 (100-210)179.7 (105-240)NSadmission Mb (μg/|)123,0 (79-1540)46.2(40.0-506)<0.00001admission TNT (μg/|)0,082(0.03-l.15)0.003 (0.00-0,01)<0.00005admission CK-MB(μg/|)54 (36-7.6)1.85(1.4-2.6)<0.00001admission ECG (ST↑)n = 50n = 9<0.00005The admission Mb, TNT and CK-MB concentrations were significantly higher in the AMI patients compared to the No-AMI patients, and there was no overlap of the 95% CI of the medians between the two groups. For AMI diagnosis, the predictive values of positive and negative tests were 0.84 and 0.62 for Mb>110μg/l; 0.70 and 0.62 for TNT>0,02 μg/l; 1.00 and 0,53 for CK-MB>9.5 μg/l, and 0.85 and 0.67 for the ECG STt,ConclusionA rise in serum Mb and TNT at admission, even below the usual diagnostic cut-off values for AMI diagnosis, has an acceptable diagnostic accuracy. For more prompt and widespread use of fibrinolytic therapy we propose a lowering of the diagnostic cut-off values for serum Mb, TNT and CK-MB for admission diagnosis of MI