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Early diagnosis of myocardial infarction with sensitive cardiac troponin assays.
- Source :
-
The New England journal of medicine [N Engl J Med] 2009 Aug 27; Vol. 361 (9), pp. 858-67. - Publication Year :
- 2009
-
Abstract
- Background: The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need.<br />Methods: We conducted a multicenter study to examine the diagnostic accuracy of new, sensitive cardiac troponin assays performed on blood samples obtained in the emergency department from 718 consecutive patients who presented with symptoms suggestive of acute myocardial infarction. Cardiac troponin levels were determined in a blinded fashion with the use of four sensitive assays (Abbott-Architect Troponin I, Roche High-Sensitive Troponin T, Roche Troponin I, and Siemens Troponin I Ultra) and a standard assay (Roche Troponin T). The final diagnosis was adjudicated by two independent cardiologists.<br />Results: Acute myocardial infarction was the adjudicated final diagnosis in 123 patients (17%). The diagnostic accuracy of measurements obtained at presentation, as quantified by the area under the receiver-operating-characteristic curve (AUC), was significantly higher with the four sensitive cardiac troponin assays than with the standard assay (AUC for Abbott-Architect Troponin I, 0.96; 95% confidence interval [CI], 0.94 to 0.98; for Roche High-Sensitive Troponin T, 0.96; 95% CI, 0.94 to 0.98; for Roche Troponin I, 0.95; 95% CI, 0.92 to 0.97; and for Siemens Troponin I Ultra, 0.96; 95% CI, 0.94 to 0.98; vs. AUC for the standard assay, 0.90; 95% CI, 0.86 to 0.94). Among patients who presented within 3 hours after the onset of chest pain, the AUCs were 0.93 (95% CI, 0.88 to 0.99), 0.92 (95% CI, 0.87 to 0.97), 0.92 (95% CI, 0.86 to 0.99), and 0.94 (95% CI, 0.90 to 0.98) for the sensitive assays, respectively, and 0.76 (95% CI, 0.64 to 0.88) for the standard assay. We did not assess the effect of the sensitive troponin assays on clinical management.<br />Conclusions: The diagnostic performance of sensitive cardiac troponin assays is excellent, and these assays can substantially improve the early diagnosis of acute myocardial infarction, particularly in patients with a recent onset of chest pain. (ClinicalTrials.gov number, NCT00470587.)<br /> (2009 Massachusetts Medical Society)
- Subjects :
- Aged
Aged, 80 and over
Angina, Unstable blood
Angina, Unstable diagnosis
Area Under Curve
Biomarkers blood
Chest Pain etiology
Creatine Kinase, MB Form blood
Early Diagnosis
Electrocardiography
Female
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction blood
Myoglobin blood
ROC Curve
Sensitivity and Specificity
Myocardial Infarction diagnosis
Troponin blood
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 361
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 19710484
- Full Text :
- https://doi.org/10.1056/NEJMoa0900428