Myoglobin and troponin I elevation predict 5-year mortality in patients with undifferentiated chest pain in the emergency department

Zehra Jaffery, Richard Nowak, Nabil Khoury, Glen Tokarski, David E. Lanfear, Gordon Jacobsen, James McCord

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: The long-term prognostic significance of elevated cardiac markers in an undifferentiated patient population with chest pain is unknown. Methods: Serum troponin I (cTnI), creatine kinase-MB (CK-MB), and myoglobin were measured at presentation in 951 consecutive patients evaluated in the emergency department for possible acute coronary syndrome, and all-cause mortality was measured over 5 years. Results: Final diagnoses included myocardial infarction in 70 (7.4%), unstable angina in 78 (8.2%), stable angina in 26 (2.7%), heart failure in 135 (14.2%), syncope in 61 (6.4%), arrhythmia in 62 (6.5%), and noncardiac diagnoses in 519 (54.6%). Our study population had a mean (±SD) age of 63 (±16), 434 (46%) were male, 774 (81%) were African American, 408 (43%) had known coronary artery disease, 647 (68%) had hypertension, 244 (26%) had diabetes mellitus, and 237 (25%) had a serum creatinine ≥1.5 mg/dL. At 5 years, there were 349 (36.7%) deaths. In a multivariate model with adjustment for baseline covariates, an elevated cTnI ≥1.0 ng/mL (hazard ratio [HR] 1.7, 95% CI 1.3-2.3) and myoglobin ≥200 ng/mL (HR 1.6, 95% CI 1.2-2.1), but not CK-MB ≥9.0 ng/mL (HR 0.9, 95% CI 0.6-1.3), remained independent predictors of all-cause mortality. Patients with both elevated cTnI and myoglobin had a particularly high mortality rate. Conclusion: Among patients evaluated in the emergency department for possible acute coronary syndromes, myoglobin and cTnI at presentation are powerful, independent predictors of long-term (5-year) prognosis.

Original languageEnglish (US)
Pages (from-to)939-945
Number of pages7
JournalAmerican Heart Journal
Volume156
Issue number5
DOIs
StatePublished - Nov 2008
Externally publishedYes

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Troponin I
Myoglobin
Chest Pain
Hospital Emergency Service
MB Form Creatine Kinase
Mortality
Acute Coronary Syndrome
Stable Angina
Unstable Angina
Syncope
Serum
African Americans
Population
Cardiac Arrhythmias
Coronary Artery Disease
Creatinine
Diabetes Mellitus
Heart Failure
Myocardial Infarction
Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Myoglobin and troponin I elevation predict 5-year mortality in patients with undifferentiated chest pain in the emergency department. / Jaffery, Zehra; Nowak, Richard; Khoury, Nabil; Tokarski, Glen; Lanfear, David E.; Jacobsen, Gordon; McCord, James.

In: American Heart Journal, Vol. 156, No. 5, 11.2008, p. 939-945.

Research output: Contribution to journalArticle

Jaffery, Zehra ; Nowak, Richard ; Khoury, Nabil ; Tokarski, Glen ; Lanfear, David E. ; Jacobsen, Gordon ; McCord, James. / Myoglobin and troponin I elevation predict 5-year mortality in patients with undifferentiated chest pain in the emergency department. In: American Heart Journal. 2008 ; Vol. 156, No. 5. pp. 939-945.
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abstract = "Background: The long-term prognostic significance of elevated cardiac markers in an undifferentiated patient population with chest pain is unknown. Methods: Serum troponin I (cTnI), creatine kinase-MB (CK-MB), and myoglobin were measured at presentation in 951 consecutive patients evaluated in the emergency department for possible acute coronary syndrome, and all-cause mortality was measured over 5 years. Results: Final diagnoses included myocardial infarction in 70 (7.4{\%}), unstable angina in 78 (8.2{\%}), stable angina in 26 (2.7{\%}), heart failure in 135 (14.2{\%}), syncope in 61 (6.4{\%}), arrhythmia in 62 (6.5{\%}), and noncardiac diagnoses in 519 (54.6{\%}). Our study population had a mean (±SD) age of 63 (±16), 434 (46{\%}) were male, 774 (81{\%}) were African American, 408 (43{\%}) had known coronary artery disease, 647 (68{\%}) had hypertension, 244 (26{\%}) had diabetes mellitus, and 237 (25{\%}) had a serum creatinine ≥1.5 mg/dL. At 5 years, there were 349 (36.7{\%}) deaths. In a multivariate model with adjustment for baseline covariates, an elevated cTnI ≥1.0 ng/mL (hazard ratio [HR] 1.7, 95{\%} CI 1.3-2.3) and myoglobin ≥200 ng/mL (HR 1.6, 95{\%} CI 1.2-2.1), but not CK-MB ≥9.0 ng/mL (HR 0.9, 95{\%} CI 0.6-1.3), remained independent predictors of all-cause mortality. Patients with both elevated cTnI and myoglobin had a particularly high mortality rate. Conclusion: Among patients evaluated in the emergency department for possible acute coronary syndromes, myoglobin and cTnI at presentation are powerful, independent predictors of long-term (5-year) prognosis.",
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T1 - Myoglobin and troponin I elevation predict 5-year mortality in patients with undifferentiated chest pain in the emergency department

AU - Jaffery, Zehra

AU - Nowak, Richard

AU - Khoury, Nabil

AU - Tokarski, Glen

AU - Lanfear, David E.

AU - Jacobsen, Gordon

AU - McCord, James

PY - 2008/11

Y1 - 2008/11

N2 - Background: The long-term prognostic significance of elevated cardiac markers in an undifferentiated patient population with chest pain is unknown. Methods: Serum troponin I (cTnI), creatine kinase-MB (CK-MB), and myoglobin were measured at presentation in 951 consecutive patients evaluated in the emergency department for possible acute coronary syndrome, and all-cause mortality was measured over 5 years. Results: Final diagnoses included myocardial infarction in 70 (7.4%), unstable angina in 78 (8.2%), stable angina in 26 (2.7%), heart failure in 135 (14.2%), syncope in 61 (6.4%), arrhythmia in 62 (6.5%), and noncardiac diagnoses in 519 (54.6%). Our study population had a mean (±SD) age of 63 (±16), 434 (46%) were male, 774 (81%) were African American, 408 (43%) had known coronary artery disease, 647 (68%) had hypertension, 244 (26%) had diabetes mellitus, and 237 (25%) had a serum creatinine ≥1.5 mg/dL. At 5 years, there were 349 (36.7%) deaths. In a multivariate model with adjustment for baseline covariates, an elevated cTnI ≥1.0 ng/mL (hazard ratio [HR] 1.7, 95% CI 1.3-2.3) and myoglobin ≥200 ng/mL (HR 1.6, 95% CI 1.2-2.1), but not CK-MB ≥9.0 ng/mL (HR 0.9, 95% CI 0.6-1.3), remained independent predictors of all-cause mortality. Patients with both elevated cTnI and myoglobin had a particularly high mortality rate. Conclusion: Among patients evaluated in the emergency department for possible acute coronary syndromes, myoglobin and cTnI at presentation are powerful, independent predictors of long-term (5-year) prognosis.

AB - Background: The long-term prognostic significance of elevated cardiac markers in an undifferentiated patient population with chest pain is unknown. Methods: Serum troponin I (cTnI), creatine kinase-MB (CK-MB), and myoglobin were measured at presentation in 951 consecutive patients evaluated in the emergency department for possible acute coronary syndrome, and all-cause mortality was measured over 5 years. Results: Final diagnoses included myocardial infarction in 70 (7.4%), unstable angina in 78 (8.2%), stable angina in 26 (2.7%), heart failure in 135 (14.2%), syncope in 61 (6.4%), arrhythmia in 62 (6.5%), and noncardiac diagnoses in 519 (54.6%). Our study population had a mean (±SD) age of 63 (±16), 434 (46%) were male, 774 (81%) were African American, 408 (43%) had known coronary artery disease, 647 (68%) had hypertension, 244 (26%) had diabetes mellitus, and 237 (25%) had a serum creatinine ≥1.5 mg/dL. At 5 years, there were 349 (36.7%) deaths. In a multivariate model with adjustment for baseline covariates, an elevated cTnI ≥1.0 ng/mL (hazard ratio [HR] 1.7, 95% CI 1.3-2.3) and myoglobin ≥200 ng/mL (HR 1.6, 95% CI 1.2-2.1), but not CK-MB ≥9.0 ng/mL (HR 0.9, 95% CI 0.6-1.3), remained independent predictors of all-cause mortality. Patients with both elevated cTnI and myoglobin had a particularly high mortality rate. Conclusion: Among patients evaluated in the emergency department for possible acute coronary syndromes, myoglobin and cTnI at presentation are powerful, independent predictors of long-term (5-year) prognosis.

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