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Previous Volume 361:858-867 August 27, 2009 Number 9 Next

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ABSTRACT

Background The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need.

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.

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.

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 [ClinicalTrials.gov] .)

Source Information

From the Department of Internal Medicine, University Hospital, Basel (T.R., W.H., C.S., S.H., S. Biedert, N.S., C.B., M.P., M.N., T.B., R.T., R.B., C.M.); Kantonsspital Olten, Olten (S. Bassetti); and Limmattalspital, Zurich (S.S.) — all in Switzerland; Herz Zentrum Bad Krozingen, Bad Krozingen, Germany (M.P.); and Centro de Investigación en Red de Enfermedades Respiratorias, SC 111 Servicio de Pneumologia, Hospital del Mar–Institut Municipal d'Investigació Mèdica, Barcelona (K.W.).

Address reprint requests to Dr. Mueller at the Department of Internal Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland, or at chmueller{at}uhbs.ch.

Full Text of this Article

This article has been cited by other articles:

• (2009). All you need to read in the other general journals. BMJ 339: b3511-b3511 [Full Text]  
• Morrow, D. A. (2009). Clinical Application of Sensitive Troponin Assays. NEJM 361: 913-915 [Full Text]  
• (2009). Clinical Performance of Newer, More-Sensitive Troponin Assays. JWatch Emergency Med. 2009: 1-1 [Full Text]