Evaluation of combined biochemical markers in the diagnosis of acute coronary syndrome in Nineveh governorate


Objective: To evaluate the importance of combination of biochemical markers in patients with Acute Coronary Syndrome (ACS) and to determine the optimal biochemical strategy for highly sensitive, early diagnosis of myocardial injury.Patients and methods: This study was carried out in coronary care unit in Ibn- Sena Teaching Hospital in Mosul city from January to November, 2008. Two hundred and forty nine patients with (ACS) presented with chest pain and one hundred and eleven apparently healthy subjects. Four cardiac markers Creatine Kinase (CK) and Creatine Kinase-MB (CK-MB) activities (markers of necrosis), myoglobin (marker of muscle injury), and troponin I (marker of necrosis) were estimated in addition to CK-MB index. The collected data were analyzed by chi square, unpaired t-test and analysis of variance (ANOVA). Receiver Operating Characteristics (ROC) analysis was used to assess the role of selected parameters in the diagnosis of ACS and to determine optimal cut-off values for all biochemical markers. Results: The optimal cut-off value of each of 5 parameters with reasonable validity were used to define single test criteria. The serum troponin I was with highest validity among other parameters. The serum troponin I was used in combination with each of the remaining 4 criteria and the test performance was assessed. All combinations were associated with higher specificity than that of serum troponin I alone. However, the accuracy of serum troponin I alone 94.0% was higher than the accuracy of all other combinations. Conclusion: The study has suggested that combining troponin I, myoglobin and CK-MB index yields satisfactory diagnostic sensitivity and thus provide valuable information for clinicians in managing Acute Coronary Syndrome (ACS).