A rapid point-of-care cardiac marker testing strategy facilitates the rapid diagnosis and management of chest pain patients in the emergency department.
We compared a rapid, point-of-care multimarker protocol with a single and serial troponin I (TnI)-only protocol in 5,244 patients admitted to the emergency department with chest pain. The diagnosis of acute myocardial infarction (AMI) was based on a doubling myoglobin level accompanied by at least a 50% increase in the creatine kinase (CK)-MB level with no detectable TnI; a doubling of myoglobin level together with any detectable TnI; or a TnI level of 0.4 ng/mL (0.4 microg/L) or more, irrespective of myoglobin or CK-MB results. By using these new criteria, 145 of 148 cases were positive for AMI (positive predictive value [PPV], 92.4%) and 3 were negative, which were also negative by the core laboratory TnI assay. Twelve confirmed non-AMI cases were positive by the new protocol, with 10 of 12 confirmed by the core laboratory as positive for TnI. The negative predictive value (NPV) was 99.9% the overall diagnostic accuracy was 99.7%. The TnI-only protocol had a sensitivity of 68.2% with an NPV of 99.1%. With lower TnI-only cutoffs, 4 patients had false-negative results, and a PPV of 36.4% was observed. Our rapid multimarker protocol seems superior to a TnI-only approach for rapidly triaging patients with chest pain or AMI.
Straface
Angela L
AL
Medical Center of Arlington, Arlington, TX, USA.
Myers
John H
JH
Kirchick
Howard J
HJ
Blick
Kenneth E
KE
D000465:Algorithms; D015415:Biomarkers / Q000097:blood*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003402:Creatine Kinase / Q000097:blood; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D003402:Creatine Kinase