Quantitative bedside testing of troponin T: is it equal to laboratory testing? The Cardiac Reader Troponin T (CARE T) study.
The progressive evolution of cardiac marker testing in patients with acute coronary syndromes has extended their role into risk stratification and guidance of therapeutic regimen. To provide utilization of cardiac markers around the clock and facilitate the diagnostic work-up of patients with acute chest pain in the emergency room, a point-of-care system for quantitative troponin T and myoglobin testing in whole blood samples was developed. Aim of this multicenter study was to evaluate bedside quantitative determination of myoglobin and troponin T in chest pain patients in a clinical routine setting. Five hospitals in Germany were contributing to blood sampling and 741 patients were included four hours (median) after onset of cardiac pain. Comparison between the rapid test and the established laboratory-based method showed a sufficient agreement of results with a correlation of r = 0.89 (Y = 0.856x + 0.029) for troponin T and r = 0.912 (Y= +1.145x + 3.457) for myoglobin. Diagnostic sensitivity and prognostic power of the troponin T results obtained in the emergency unit were thoroughly equivalent to the laboratory-based method. The results show that the cardiac reader system represents a promising alternative to central laboratory testing with an accuracy sufficiently for rapid decision making in the emergency room. Myoglobin results in this study did not add supplementary information to the cardiac reader troponin result. However, point-of-care testing of troponin T is advantageous whenever marker results could positively effect initial triage decisions and interventional management choices.
Med Clinic III/Division of Cardiology, University Hospital Eppendorf, Hamburg, Germany. goldmann@uke.uni-hamburg.de
Britta U
BU
Goldmann
Lukas
L
Langenbrink
Guido
G
Matschuck
Christopher
C
Heeschen
Susanne
S
Kolbe-Busch
Christoph
C
Niederau
Norbert
N
Katz
Claudia
C
Wenserit
Heiko-Gundmar
HG
Lestin
Kurt
K
Brinker
Eckhard
E
Kuhrt
Ullrich
U
Tebbe
Eberhard
E
Spanuth
Christian W
CW
Hamm
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis*; D000818:Animals; D015415:Biomarkers / Q000097:blood; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D019095:Point-of-Care Systems; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T