Assessing the Cardiac Signature - Correlation of Troponin and CK- MB with Acute Chest Pain in a Tertiary Care Hospital - Prospective Analysis

Background Acute Coronary Syndrome (ACS) represents a major global health challenge in both developed and developing nations, including India, despite considerable progress in diagnostic and therapeutic approaches. Conventional ACS diagnosis has traditionally depended on chest pain characteristics, electrocardiographic (ECG) alterations, and cardiac enzyme elevation. Among available biomarkers, Creatine Kinase Myocardial Band (CK-MB) and Cardiac Troponin-I (cTnI) demonstrate enhanced specificity for myocardial injury detection. This investigation aimed to evaluate serum cardiac marker variations and determine the diagnostic sensitivity and specificity of Highly Sensitive Troponin-I (hs-Trop I) and CK-MB in patients with suspected ACS. Methods This prospective observational investigation was performed over twelve months (January 2024–January 2025) and enrolled 313 patients presenting to the emergency department with acute chest pain. Serum hs-Trop I concentrations were quantified using the biomerieux MINI VIDAS instrument employing Enzyme-Linked Fluorescent Assay (ELFA) technology. CK-MB measurement was conducted using Microslide Technology with Dry Slide Reflectance Photometry. Final ACS diagnosis was determined through clinical presentation, ECG findings, and biomarker evaluation. Results Among 313 evaluated patients, 145 received confirmed ACS diagnoses. Hs-Trop I exhibited superior diagnostic performance with 100% sensitivity—attributed to high-sensitivity assay utilization and patient presentation beyond the symptom onset window (3–6 hours), permitting adequate biomarker elevation—and 82.14% specificity. Comparatively, CK-MB demonstrated 78.10% sensitivity and 71.5% specificity for ACS diagnosis. Conclusions Highly Sensitive Troponin-I represents a superior biomarker for early ACS diagnosis due to its exceptional sensitivity and diagnostic precision. CK-MB, though less sensitive, remains valuable for reinfarction detection owing to its relatively rapid normalization. Integrated clinical application of these biomarkers can strengthen diagnostic confidence in emergency care settings.