Effectiveness to identify acute myocardial infarction using the Manchester screening in patients with chest pain at the emergency service

• Published in: Journal of clinical laboratory analysis Vol. 32; no. 6; pp. e22439 - n/a
• Main Authors: Gonçalves, Simone M., Gomes, Karina B., Carvalho, Maria das G., Magalhães, Henrique P. B., Reis, Edna A., Silva, Iêda de Fátima O.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-07-2018; John Wiley and Sons Inc
• Subjects: Acute coronary syndromes; acute myocardial infarction; Angina; Biochemical markers; Brief Report; Calcium-binding protein; cardiac troponin I; Cardiovascular diseases; Chest; Creatine; Creatine kinase; creatine kinase MB mass; EKG; Electrocardiography; Emergency medical care; Heart; Heart attacks; Ischemia; Manchester Triage System; Medical records; Myocardial infarction; myoglobin; Myoglobins; Pain; Troponin; Troponin I; Manchester Triage System; creatine kinase MB mass; acute myocardial infarction; myoglobin; cardiac troponin I
• ISSN: 0887-8013; 1098-2825
• DOI: 10.1002/jcla.22439

Background
Among cardiovascular diseases (CVD), acute coronary syndrome (ACS) is the main manifestation, corresponding to signs and symptoms that occur with ischemia and outcome of angina or acute myocardial infarction (AMI). The aim of this study was to investigate the performance of biochemical markers eligible in a chest pain protocol, using Point of care Test (POCT), in patients in a reference emergency room.
Methods
In this study, 1380 medical records of patients of both genders were evaluated, ranked by applying chest pain protocol using the Manchester Triage System (MTS). Markers for myocardial injury were measured in serial analysis including myoglobin (Mgb), creatine kinase MB fraction mass (CK‐MB), and cardiac troponin I (cTnI).
Results
Acute myocardial infarction was predominant in males (P < .001), in patients with hypertension (P < .001), and in those with previous myocardial infarction (P < .026) and significant electrocardiogram (ECG) data for AMI screening (P < .001).
A multivariate regression model showed as predictors for AMI the variables ECG data by admittance at the emergency room, previous AMI history, levels of both Mgb at the third hour, and cTnI at the sixth hour after admission.
Conclusion
This study showed the importance of a rapid and serial test as a cardiac marker for AMI screening, as well as has indicated the importance of time between the onset of chest pain and admission to the emergency room as an efficient aid in diagnosing this life‐threatening disease.