The relative utility of cardiac troponin i, creatine kinase‐mb mass , and myosin light chain‐1 in the long‐term risk stratification of patients with chest pain

Background: Sensitive and specific cardiac markers convey important short‐term prognostic information about patients with an acute coronary syndrome. There are, however, few data assessing their value as long‐term predictors. Hypothesis : The aim of the current study was to assess the relative value of three such markers and clinical characteristics in determining the long‐term prognosis of patients with chest pain. Methods : Cardiac troponin I (cTnI), myosin light chain‐1 (MLC‐1), and creatine kinase‐MB mass levels were obtained on admission (0 h) and at 4, 8, 16, and 24 h in 208 patients with chest pain. Eligible subjects were determined, at the time of hospital admission, to be at > 7% risk of acute myocardial infarction (MI), but without new ST‐segment elevation on their presenting electrocardiogram. Follow‐up was performed a median of 28 (range 1‐46) months later. The primary study endpoint was death or nonfatal MI, subsequent to the index admission. Results : Cardiac TnI levels ≥ 0.2 ng/ml (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.09‐3.40) and MLC‐1 levels ≥ 1 ng/ml (OR 3.24, 95% CI 1.83‐5.73) were both significant predictors of death or MI during long‐term follow‐up; MLC‐1 was, however, the only independent biochemical predictor (OR 2.11, 95% CI 1.14‐3.93). Conclusions: Both cTnI and MLC‐1 predict the long‐term outcome of patients with chest pain, but, in this cohort, MLC‐1 proved to be a better predictor of mortality and nonfatal acute MI.