title: Sensitive troponin I assay in early diagnosis of acute myocardial infarction.
abstract: BACKGROUND
  Cardiac troponin testing is central to the diagnosis of acute myocardial infarction. We evaluated a sensitive troponin I assay for the early diagnosis and risk stratification of myocardial infarction.
  
  
  METHODS
  In a multicenter study, we determined levels of troponin I as assessed by a sensitive assay, troponin T, and traditional myocardial necrosis markers in 1818 consecutive patients with suspected acute myocardial infarction, on admission and 3 hours and 6 hours after admission.
  
  
  RESULTS
  For samples obtained on admission, the diagnostic accuracy was highest with the sensitive troponin I assay (area under the receiver-operating-characteristic curve [AUC], 0.96), as compared with the troponin T assay (AUC, 0.85) and traditional myocardial necrosis markers. With the use of the sensitive troponin I assay (cutoff value, 0.04 ng per milliliter) on admission, the clinical sensitivity was 90.7%, and the specificity was 90.2%. The diagnostic accuracy was virtually identical in baseline and serial samples, regardless of the time of chest-pain onset. In patients presenting within 3 hours after chest-pain onset, a single sensitive troponin I assay had a negative predictive value of 84.1% and a positive predictive value of 86.7%; these findings predicted a 30% rise in the troponin I level within 6 hours. A troponin I level of more than 0.04 ng per milliliter was independently associated with an increased risk of an adverse outcome at 30 days (hazard ratio, 1.96; 95% confidence interval, 1.27 to 3.05; P=0.003).
  
  
  CONCLUSIONS
  The use of a sensitive assay for troponin I improves early diagnosis of acute myocardial infarction and risk stratification, regardless of the time of chest-pain onset.
authors.affiliation: Department of Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Keller
authors.forename: Tanja
authors.initials: T
authors.lastname: Zeller
authors.forename: Dirk
authors.initials: D
authors.lastname: Peetz
authors.forename: Stergios
authors.initials: S
authors.lastname: Tzikas
authors.forename: Alexander
authors.initials: A
authors.lastname: Roth
authors.forename: Ewa
authors.initials: E
authors.lastname: Czyz
authors.forename: Christoph
authors.initials: C
authors.lastname: Bickel
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.forename: Ascan
authors.initials: A
authors.lastname: Warnholtz
authors.forename: Meike
authors.initials: M
authors.lastname: Fröhlich
authors.forename: Christoph R
authors.initials: CR
authors.lastname: Sinning
authors.forename: Medea S
authors.initials: MS
authors.lastname: Eleftheriadis
authors.forename: Philipp S
authors.initials: PS
authors.lastname: Wild
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.forename: Edith
authors.initials: E
authors.lastname: Lubos
authors.forename: Nicole
authors.initials: N
authors.lastname: Jachmann
authors.forename: Sabine
authors.initials: S
authors.lastname: Genth-Zotz
authors.forename: Felix
authors.initials: F
authors.lastname: Post
authors.forename: Viviane
authors.initials: V
authors.lastname: Nicaud
authors.forename: Laurence
authors.initials: L
authors.lastname: Tiret
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Lackner
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Münzel
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology; D015897:Comorbidity; D042241:Early Diagnosis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T