{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,15]],"date-time":"2024-09-15T13:03:45Z","timestamp":1726405425521},"reference-count":12,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2009,2,3]],"date-time":"2009-02-03T00:00:00Z","timestamp":1233619200000},"content-version":"vor","delay-in-days":2774,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2001,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Background:<\/jats:italic> Millions of patients present annually with chest pain, but only 10% have myocardial infarction (MI). We recently reported comparative sensitivity and specificity of available markers in the diagnosis of MI; however, optimum interpretation of marker results requires prognostic follow\u2010up data.<\/jats:p><jats:p><jats:italic>Hypothesis:<\/jats:italic> The study was undertaken to study the accuracy of CK\u2010MB subforms, troponin I and T, myoglobin, and CK\u2010MB in predicting clinical events at 30 days and 6 months.<\/jats:p><jats:p><jats:italic>Methods:<\/jats:italic> in all, 955 consecutive patients with chest pain were enrolled in a prospective, multicenter, double\u2010blind study to test the prognostic accuracy of these markers.<\/jats:p><jats:p><jats:italic>Results:<\/jats:italic> Myocardial infarction was diagnosed in 119 by CK\u2010MB mass criteria and unstable angina (UA) in 203 patients by clinical criteria. Follow\u2010up at 30 days and 6 months was available in 824 and 724 patients, respectively, with mortalities of 2.8 and 4.14%, respectively. Cumulative 6\u2010month mortality was 5.6% in MI, 4.4% in UA, and 3.0% in others. Revascularization was reported in 9.3% of patients by 6 months. A positive test on each of the markers except myoglobin was predictive of revascularization. The composite endpoint of death or revascularization occurred in 107 patients by 6 months and a positive result on each of the markers was predictive of this composite endpoint (p &lt; 0.05). The relative risk of death or revascularization for patients who did not have MI but tested positive on each of the markers was &gt; 1.0 but did not reach statistical significance.<\/jats:p><jats:p><jats:italic>Conclusions:<\/jats:italic> With the possible exception of myoglobin, each of the diagnostic markers displayed similar prognostic performance in patients with chest pain presenting to emergency departments. The most appropriate markers to triage patients with chest pain, which has both adequate early diagnostic sensitivity and prognostic accuracy, are the CK\u2010MB subforms.<\/jats:p>","DOI":"10.1002\/clc.4960240708","type":"journal-article","created":{"date-parts":[[2009,2,3]],"date-time":"2009-02-03T23:08:55Z","timestamp":1233702535000},"page":"516-520","source":"Crossref","is-referenced-by-count":5,"title":["A double\u2010blind, multicentered study comparing the accuracy of diagnostic markers to predict short\u2010 and long\u2010term clinical events and their utility in patients presenting with chest pain"],"prefix":"10.1002","volume":"24","author":[{"given":"Robert","family":"Fromm","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel","family":"Habib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janice","family":"Zimmerman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Boudreaux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Smalling","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuan\u2010Chuan C.","family":"Wun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barry","family":"Davis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,2,3]]},"reference":[{"key":"e_1_2_1_2_2","first-page":"71","volume-title":"ACC Current Journal Review","author":"Fisch C","year":"1997"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.13.1671"},{"volume-title":"Comparative Clinical and Financial Standards, 1998","year":"1998","author":"The DRG Handbook","key":"e_1_2_1_4_2"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199409013310901"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199610313351801"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199610313351802"},{"key":"e_1_2_1_8_2","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/S0196-0644(05)81945-6","article-title":"Missed diagnoses of acute myocardial infarction in the emergency department: Results from a multicenter study","volume":"22","author":"McCarthy BD","year":"1993","journal-title":"Ann Emerg Med"},{"key":"e_1_2_1_9_2","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/0002-9149(87)90217-7","article-title":"Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room","volume":"60","author":"Lee TH","year":"1987","journal-title":"Am J Cardiol"},{"key":"e_1_2_1_10_2","unstructured":"BraunwaldE MarkDB JonesRH CheitlinMD FusterV McCauleyKM EdwardsC GreenLA MushlinAI SwainJA SmithEE III CowanM RoseGC ConcannonCA GrinesCL BrownL LytleBW GoldmanL TopolEJ WillersonJT BrownJ ArchibaldN:Unstable Angina: Diagnosis and Management. 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