title: High-sensitivity versus conventional troponin in the emergency department for the diagnosis of acute myocardial infarction.
abstract: BACKGROUND
  Recently, newer assays for cardiac troponin (cTn) have been developed which are able to detect changes in concentration of the biomarker at or below the 99th percentile for a normal population. The objective of this study was to compare the diagnostic performance of a new high-sensitivity troponin T (HsTnT) assay to that of conventional cTnI for the diagnosis of acute myocardial infarction (AMI) according to pretest probability (PTP).
  
  
  METHODS
  In consecutive patients who presented to our emergency departments with chest pain suggestive of AMI, levels of HsTnT were measured at presentation, blinded to the emergency physicians, who were asked to estimate the empirical PTP of AMI. The discharge diagnosis was adjudicated by two independent experts on the basis of all available data.
  
  
  RESULTS
  A total of 317 patients were included, comprising 149 (47%) who were considered to have low PTP, 109 (34%) who were considered to have moderate PTP and 59 (19%) who were considered to have high PTP. AMI was confirmed in 45 patients (14%), 22 (9%) of whom were considered to have low to moderate PTP and 23 (39%) of whom were considered to have high PTP (P < 0.001). In the low to moderate PTP group, HsTnT levels ≥ 0.014 μg/L identified AMI with a higher sensitivity than cTnI (91%, 95% confidence interval (95% CI) 79 to 100, vs. 77% (95% CI 60 to 95); P = 0.001), but the negative predictive value was not different (99% (95% CI 98 to 100) vs. 98% (95% CI 96 to 100)). There was no difference in area under the receiver operating characteristic (ROC) curve between HsTnT and cTnI (0.93 (95% CI 0.90 to 0.98) vs. 0.94 (95% CI 0.88 to 0.97), respectively).
  
  
  CONCLUSIONS
  In patients with low to moderate PTP of AMI, HsTnT is slightly more useful than cTnI. Our results confirm that the use of HsTnT has a higher sensitivity than conventional cTnI.
authors.affiliation: Department of Emergency Medicine and Surgery, Hôpital Pitié-Salpétrière, Université Pierre et Marie Curie-Paris 6, 47-83 boulevard de l'hôpital, F-75651 Paris cedex 13, France. yonatman@gmail.com
authors.forename: Yonathan
authors.initials: Y
authors.lastname: Freund
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.forename: Pascale
authors.initials: P
authors.lastname: Bonnet
authors.forename: Yann-Erick
authors.initials: YE
authors.lastname: Claessens
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Allo
authors.forename: Benoit
authors.initials: B
authors.lastname: Doumenc
authors.forename: François
authors.initials: F
authors.lastname: Leumani
authors.forename: Claudine
authors.initials: C
authors.lastname: Cosson
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin