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Titolo:
Myoglobin for early risk stratification of emergency department patients with possible myocardial ischemia
Autore:
Green, GB; Skarbek-Borowski, GW; Chan, DW; Kelen, GD;
Indirizzi:
Johns Hopkins Univ, Sch Med, Dept Emergency Med, Baltimore, MD 21287 USA Johns Hopkins Univ Baltimore MD USA 21287 cy Med, Baltimore, MD 21287 USA Johns Hopkins Univ, Sch Med, Dept Pathol, Baltimore, MD 21287 USA Johns Hopkins Univ Baltimore MD USA 21287 Pathol, Baltimore, MD 21287 USA
Titolo Testata:
ACADEMIC EMERGENCY MEDICINE
fascicolo: 6, volume: 7, anno: 2000,
pagine: 625 - 636
SICI:
1069-6563(200006)7:6<625:MFERSO>2.0.ZU;2-U
Fonte:
ISI
Lingua:
ENG
Soggetto:
CREATINE-KINASE-MB; CARDIAC TROPONIN-I; ACUTE CHEST PAIN; CK-MB; UNSTABLE ANGINA; SERUM MYOGLOBIN; PROGNOSTIC VALUE; EARLY DIAGNOSIS; INFARCTION; IMMUNOASSAY;
Keywords:
myoglobin; emergency department; prognosis; myocardial ischemia; CK-MB; troponin;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
40
Recensione:
Indirizzi per estratti:
Indirizzo: Green, GB Johns Hopkins Univ, Sch Med, Dept Emergency Med, 600 N Wolfe St,Marburg B186, Baltimore, MD 21287 USA Johns Hopkins Univ 600 N Wolfe St,Marburg B186 Baltimore MD USA 21287
Citazione:
G.B. Green et al., "Myoglobin for early risk stratification of emergency department patients with possible myocardial ischemia", ACAD EM MED, 7(6), 2000, pp. 625-636

Abstract

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 earlyprognostic 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 12:27:10