Cardiac troponin I for the diagnosis of acute myocardial infarction in the emergency department.
Cardiac troponin I (TnI) was tested in 316 consecutive patients with chest pain who were admitted to the emergency department, of whom 62 were discharged with a diagnosis of acute myocardial infarction (AMI). The TnI level was abnormal in 49 patients with AMI compared with 27 for creatine kinase (CK)-MB in the first specimen obtained at admission. All 62 patients with AMI were correctly diagnosed at admission with a combination of TnI and myoglobin testing. The overall peak performance of TnI testing in samples received within 24 hours of admission indicated high sensitivity (97%) and specificity (98%) for the diagnosis of AMI. The TnI was positive in elderly patients with myocardial injury and low CK and normal CK-MB values. These data suggest that testing for TnI could replace CK-MB and, in combination with myoglobin, could facilitate the rapid and effective triage of patients with chest pain in the emergency department.
D'Costa
M
M
Department of Laboratory Medicine, St Joseph's Health Centre, Toronto, Ontario, Canada.
Fleming
E
E
Patterson
M C
MC
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D019540:Area Under Curve; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013997:Time Factors; D014218:Triage; D019210:Troponin I / Q000097:blood*
D007527:Isoenzymes; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase