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Comparison of high sensitivity and contemporary troponin assays for the early detection of acute myocardial infarction in the emergency department.

Abstract：

BACKGROUND:Current guidelines define acute myocardial infarction (AMI) by the rise and/or fall of cardiac troponin with ≥1 value above the 99th percentile. Past troponin assays have been unreliable at the lower end of the range. Highly sensitive assays have therefore been developed to increase the clinical sensitivity for detection of myocardial injury. METHODS:Three hundred and thirty-two patients with chest pain suggestive of AMI were prospectively recruited between November 2006 and April 2007. Serial blood samples were analysed to compare Roche Elecsys high sensitivity troponin T (hsTnT), Abbott Architect troponin I 3rd generation (TnI 3) and Roche Elecsys troponin T (TnT) for the diagnosis of AMI. RESULTS:One hundred and ten (33.1%) patients were diagnosed with AMI. Test performance for the diagnosis of AMI, as quantified by receiver operating characteristic area under the curve (95% confidence intervals) for baseline/follow-up troponins were as follows: hsTnT 0.90 (0.87-0.94)/0.94 (0.91-0.97), TnI 3 0.88 (0.84-0.92)/0.93 (0.90-0.96) and TnT 0.80 (0.74-0.85)/0.89 (0.85-0.94). hsTnT was superior to TnT (P < 0.001/0.013 at baseline/follow-up) but equivalent to TnI 3. For patients with a final diagnosis of AMI, baseline troponins were raised in more patients for hsTnT (83.6%) than TnI 3 (74.5%) and TnT (62.7%). A delta troponin of ≥20% increased the specificity of hsTnT from 80.6% to 93.7% but reduced sensitivity from 90.9% to 71.8%. CONCLUSION:hsTnT was superior to TnT but equivalent to TnI 3 for the diagnosis of AMI. Serial troponin measurement increased test performance. hsTnT was the most likely to be raised at baseline in those with AMI. A delta troponin increases specificity but reduces sensitivity.

journal_name

Ann Clin Biochem

journal_title

Annals of clinical biochemistry

authors

Aldous SJ,Florkowski CM,Crozier IG,Elliott J,George P,Lainchbury JG,Mackay RJ,Than M,Flaws DF,Borowsky J

doi

10.1258/acb.2010.010219

subject

Has Abstract

pub_date

2011-05-01 00:00:00

pages

241-8

issue

Pt 3

eissn

0004-5632

issn

1758-1001

pii

acb.2010.010219

journal_volume

pub_type

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Comparison of high sensitivity and contemporary troponin assays for the early detection of acute myocardial infarction in the emergency department.