Biochemical Markers of Ischaemia for the Early Identification of Acute Myocardial Infarction without ST Segment Elevation

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Abstract
Blood was collected on admission and after 1–2 h in 130 consecutive patients admitted with typical chest pain in order to assess the capacity of myoglobin, fatty-acid-binding protein (FABP), CK-MB mass, and troponin I (TnI) in the early identification of acute myocardial infarction (AMI) without ST elevation. Using the maximum value within 6 h of onset of symptoms, AMI was detected with a 90–95% sensitivity and a 81–94% specificity by FABP at a cut-off level 8–12 µg/l, or 81–86% and 89–93%, respectively, by myoglobin at a cut-off level 70–90 µg/l. CK-MB mass and TnI had low sensitivity, albeit very high specificity. As almost all AMI patients were identified within 6 h, serial measurements of FABP or myoglobin ruled out AMI with a very high degree of certainty. Due to the low prevalence of AMI (16%), the positive predictive values were modest (47–73%), yet increasing the probability of AMI by a factor 3–4. Myoglobin and FABP are very useful markers in the early triage of chest pain patients.