We conducted a prospective study of 152 adult patients presenting to an emergency department with
chest pain or symptoms suggestive of acute
myocardial infarction (AMI) to evaluate the first electrocardiogram (ECG),
creatine kinase (CK)-MB and
Troponin-T Rapid Assay (
TnT) alone or in combination with
chest pain in the initial diagnosis of AMI. A provisional diagnosis was made after the history, physical examination and the first ECG reading. Blood specimens were taken for
TnT, CK and CK-MB mass. A final discharge diagnosis of AMI was made according to World Health Organization criteria. Seventy-six (50%) of patients had a final diagnosis of AMI. The sensitivities of the first ECG, first CK-MB mass and first
TnT were 76.3% (95% confidence interval (CI), 66.8-85.9), 38.2% (95% CI, 27.2-49.1) and 31.6% (95% CI, 21.2-42.0) respectively. The area under the curve for a combination of ECG, CK-MB mass,
TnT and
chest pain was the highest at 0.937 when compared with
chest pain with varying combinations of tests. A combination of the first ECG, CK-MB mass and
TnT had a negative predictive value (NPV) of 87.9% (95% CI, 80.0-95.8). The first ECG was the most sensitive test while the combination of
chest pain, ECG, cardiac
enzymes and
TnT gave the best results in the initial diagnosis of AMI. If the first ECG, CK-MB mass and
TnT are all negative, the probability of having an AMI is 12%.