title: Rapid detection of myocardial infarction with a sensitive troponin test.
abstract: Rapid identification and treatment of patients with a myocardial infarction (MI) is mandatory. We studied the diagnostic capacities of a sensitive troponin assay for detection of MI in emergency department patients within 2 hours after arrival. The study included 157 patients suspected of having non-ST-elevation acute coronary syndrome. Blood was drawn on arrival (T0) and 2 (T2), 6, and 12 hours later. At T2, a troponin concentration above the MI cutoff is 87% sensitive and 100% specific for MI detection (positive predictive value [PPV], 100%; negative predictive value [NPV], 96%). If a difference of more than 30% between the troponin measurements at T0 and T2 in the absence of an absolute troponin increase above the 99th percentile of a reference population is also considered indicative of MI, the sensitivity increases to 100% and specificity decreases to 87% (PPV, 70%; NPV, 100%). Sensitivity and specificity of creatine kinase-MB and myoglobin are lower than those of troponin. By using a sensitive troponin assay and simple algorithms, the diagnosis of MI can be determined within 2 hours after arrival at the emergency department. Measurement of myoglobin and creatine kinase-MB has no added value.
authors.affiliation: Clinical Laboratory, Catharina Hospital, Eindhoven, the Netherlands.
authors.forename: Volkher
authors.initials: V
authors.lastname: Scharnhorst
authors.forename: Krisztina
authors.initials: K
authors.lastname: Krasznai
authors.forename: Marcel
authors.initials: M
authors.lastname: van't Veer
authors.forename: Rolf
authors.initials: R
authors.lastname: Michels
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D003937:Diagnosis, Differential; D004635:Emergency Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D020107:Troponin T; D052279:Creatine Kinase, MB Form