Early diagnosis of myocardial infarction with sensitive cardiac troponin assays.
BACKGROUND
The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need.


METHODS
We conducted a multicenter study to examine the diagnostic accuracy of new, sensitive cardiac troponin assays performed on blood samples obtained in the emergency department from 718 consecutive patients who presented with symptoms suggestive of acute myocardial infarction. Cardiac troponin levels were determined in a blinded fashion with the use of four sensitive assays (Abbott-Architect Troponin I, Roche High-Sensitive Troponin T, Roche Troponin I, and Siemens Troponin I Ultra) and a standard assay (Roche Troponin T). The final diagnosis was adjudicated by two independent cardiologists.


RESULTS
Acute myocardial infarction was the adjudicated final diagnosis in 123 patients (17%). The diagnostic accuracy of measurements obtained at presentation, as quantified by the area under the receiver-operating-characteristic curve (AUC), was significantly higher with the four sensitive cardiac troponin assays than with the standard assay (AUC for Abbott-Architect Troponin I, 0.96; 95% confidence interval [CI], 0.94 to 0.98; for Roche High-Sensitive Troponin T, 0.96; 95% CI, 0.94 to 0.98; for Roche Troponin I, 0.95; 95% CI, 0.92 to 0.97; and for Siemens Troponin I Ultra, 0.96; 95% CI, 0.94 to 0.98; vs. AUC for the standard assay, 0.90; 95% CI, 0.86 to 0.94). Among patients who presented within 3 hours after the onset of chest pain, the AUCs were 0.93 (95% CI, 0.88 to 0.99), 0.92 (95% CI, 0.87 to 0.97), 0.92 (95% CI, 0.86 to 0.99), and 0.94 (95% CI, 0.90 to 0.98) for the sensitive assays, respectively, and 0.76 (95% CI, 0.64 to 0.88) for the standard assay. We did not assess the effect of the sensitive troponin assays on clinical management.


CONCLUSIONS
The diagnostic performance of sensitive cardiac troponin assays is excellent, and these assays can substantially improve the early diagnosis of acute myocardial infarction, particularly in patients with a recent onset of chest pain. (ClinicalTrials.gov number, NCT00470587.)
Reichlin
Tobias
T
Department of Internal Medicine, University Hospital, Basel, Switzerland.
Hochholzer
Willibald
W
Bassetti
Stefano
S
Steuer
Stephan
S
Stelzig
Claudia
C
Hartwiger
Sabine
S
Biedert
Stefan
S
Schaub
Nora
N
Buerge
Christine
C
Potocki
Mihael
M
Noveanu
Markus
M
Breidthardt
Tobias
T
Twerenbold
Raphael
R
Winkler
Katrin
K
Bingisser
Roland
R
Mueller
Christian
C
D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D052279:Creatine Kinase, MB Form / Q000097:blood; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014336:Troponin / Q000097:blood*
D015415:Biomarkers; D009211:Myoglobin; D014336:Troponin; D052279:Creatine Kinase, MB Form