Rapid assessment of patients with non-ST-segment elevation acute chest pain: troponins, inflammatory markers, or perfusion imaging?

J Nucl Cardiol. Sep-Oct 2002;9(5):491-9. doi: 10.1067/mnc.2002.125216.

Abstract

Background: Perfusion imaging during or soon after pain has been shown to provide diagnostic and prognostic information in patients with suspected angina. Measurement of troponin I (TnI) and troponin T (TnT) provides similar information but only several hours after onset of pain. The role of inflammatory markers in this setting is less clear.

Methods and results: We prospectively studied 80 nonconsecutive patients using gated technetium 99m sestamibi single photon emission computed tomography (MIBI), TnT, TnI, C-reactive protein, IL-6, and tumor necrosis factor alpha. Of these patients, 50 (63%) had abnormal MIBI, 13 (17%) had elevated TnT, 17 (21%) had elevated TnI, and C-reactive protein, IL-6, and tumor necrosis factor alpha were raised in 46 (58%), 14 (18%), and 29 (37%), respectively. Myocardial infarction was the presenting event in 13 patients (16%), and 23 (34%) of those without index myocardial infarction sustained a cardiovascular event during follow-up. MIBI, TnT, TnI, and electrocardiogram all had similar negative predictive values for index myocardial infarction (97%, 97%, 95%, and 97%, respectively). However, only MIBI had a high negative predictive value for the prediction of subsequent events during follow-up (86%). TnT and MIBI were the only independent predictors of all events. Inflammatory markers provided no useful additional prognostic information.

Conclusions: The combination of TnT and MIBI is the best model for early prediction of cardiac events in patients with acute chest pain.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Biomarkers / analysis
  • C-Reactive Protein / analysis
  • Chest Pain / etiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Interleukin-6 / blood
  • Male
  • Middle Aged
  • Myocardial Infarction / complications*
  • Myocardial Infarction / diagnosis*
  • Predictive Value of Tests
  • Prospective Studies
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Statistics as Topic
  • Technetium Tc 99m Sestamibi*
  • Troponin / blood*
  • Troponin I / blood*
  • Tumor Necrosis Factor-alpha / analysis

Substances

  • Biomarkers
  • Interleukin-6
  • Radiopharmaceuticals
  • Troponin
  • Troponin I
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein
  • Technetium Tc 99m Sestamibi