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.
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.
Authors: L Goldman; E F Cook; D A Brand; T H Lee; G W Rouan; M C Weisberg; D Acampora; C Stasiulewicz; J Walshon; G Terranova Journal: N Engl J Med Date: 1988-03-31 Impact factor: 91.245
Authors: M D Duca; S Giri; A H Wu; R S Morris; G M Cyr; A Ahlberg; M White; D D Waters; G V Heller Journal: J Nucl Cardiol Date: 1999 Nov-Dec Impact factor: 5.952
Authors: L M Biasucci; G Liuzzo; R L Grillo; G Caligiuri; A G Rebuzzi; A Buffon; F Summaria; F Ginnetti; G Fadda; A Maseri Journal: Circulation Date: 1999-02-23 Impact factor: 29.690
Authors: E M Antman; M J Tanasijevic; B Thompson; M Schactman; C H McCabe; C P Cannon; G A Fischer; A Y Fung; C Thompson; D Wybenga; E Braunwald Journal: N Engl J Med Date: 1996-10-31 Impact factor: 91.245
Authors: E M Ohman; P W Armstrong; R H Christenson; C B Granger; H A Katus; C W Hamm; M A O'Hanesian; G S Wagner; N S Kleiman; F E Harrell; R M Califf; E J Topol Journal: N Engl J Med Date: 1996-10-31 Impact factor: 91.245