title: Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I.
abstract: BACKGROUND
  Diagnostic strategies with ECG and serum cardiac markers have been used to rule out acute myocardial infarction in 6 to 12 hours. The present study evaluated whether a multimarker strategy that used point-of-care measurement of myoglobin, creatine kinase (CK)-MB, and troponin I could exclude acute myocardial infarction in </=3 hours.
  
  
  RESULTS
  We prospectively enrolled consecutive patients (n=817) in the emergency department who were evaluated for possible acute myocardial infarction. In patients with nondiagnostic ECGs, we measured CK-MB, troponin I, and myoglobin with a point-of-care device at presentation and at 90 minutes, 3 hours, and 9 hours. Standard central laboratory testing of CK-MB was done at the same time intervals, and triage decisions were made by emergency physicians who were unaware of point-of-care results. Sensitivity and negative predictive value were compared for both the multimarker, point-of-care approach and the central laboratory strategy. Sensitivity and negative predictive value for point-of-care combination of myoglobin and troponin I by 90 minutes was 96.9% and 99.6%, respectively. CK-MB measurements and blood sampling at 3 hours did not improve sensitivity or negative predictive value. Median time from sampling to reporting of results was 71.0 minutes for the central laboratory versus 24.0 minutes for the point-of-care device (P<0.001).
  
  
  CONCLUSIONS
  Acute myocardial infarction can be excluded rapidly in the emergency department by use of point-of-care measurements of myoglobin and troponin I during the first 90 minutes after presentation.
authors.affiliation: Henry Ford Hospital Center, 2799 W Grand Blvd, Detroit, MI 48202, USA. jmccord1@hfhs.org
authors.forename: J
authors.initials: J
authors.lastname: McCord
authors.forename: R M
authors.initials: RM
authors.lastname: Nowak
authors.forename: P A
authors.initials: PA
authors.lastname: McCullough
authors.forename: C
authors.initials: C
authors.lastname: Foreback
authors.forename: S
authors.initials: S
authors.lastname: Borzak
authors.forename: G
authors.initials: G
authors.lastname: Tokarski
authors.forename: M C
authors.initials: MC
authors.lastname: Tomlanovich
authors.forename: G
authors.initials: G
authors.lastname: Jacobsen
authors.forename: W D
authors.initials: WD
authors.lastname: Weaver
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood*; D019095:Point-of-Care Systems; D011379:Prognosis; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I