Indications and Clinical Utility of Cardiac Biomarkers in the Emergency Room of a Nigerian Tertiary Hospital

Abstract

Background: The prevalence of acute coronary syndrome (ACS) in Nigeria is on the rise with dire morbidity and mortality risks. Cardiac biomarkers are rapid and sensitive tools used as adjunct in the diagnosis of ACS. The clinical utility of cardiac biomarkers is yet to be well explored in Nigerian setting. Objectives: To determine the indications and clinical utility of cardiac biomarkers as well as their electrocardiographic (ECG) changes. Methods: This study is a retrospective review of all patients who had point-of-care serum Troponin-I, Creatine kinase MB isoenzyme and myoglobin done at the medical emergency department of LASUTH over a three year period (January 2017 to December 2019). Their records were retrieved; demographics, indications for testing and ECG findings were recorded. Data was analyzed using SPSS version 20.0 software. Results: 593 tests were done in the 3 years period of study. Only 397 patients had complete records. 48.6% were male. The mean age of the study population was 55.02 + 16.64 years (range 13-94 years). Chest pain was the commonest indication for test (91%). Other indications are loss of consciousness, palpitations, seizures and unexplained dyspnea.  Mean duration of chest pain prior to presentation was 9 days. 16.1% (64 patients) of patients tested had elevated cardiac biomarkers and 87.5% of those with elevated cardiac biomarkers had abnormal ECG suggestive of ACS. Conclusion: This study showed that cardiac biomarker is an important point-of-care test in the evaluation of chest pain. Cardiac biomarkers should therefore be a routine test in the emergency room.