title: Very early diagnosis of chest pain by point-of-care testing: comparison of the diagnostic efficiency of a panel of cardiac biomarkers compared with troponin measurement alone in the RATPAC trial.
abstract: OBJECTIVE
  To assess the impact of triple marker testing on patient management and the diagnostic efficiencies of different biomarker strategies examined.
  
  
  METHODS
  A prospective randomised trial of triple marker testing by point-of-care testing (POCT); the Randomised Assessment of Panel Assay of Cardiac markers (RATPAC) study.
  
  
  METHODS
  Six emergency departments.
  
  
  METHODS
  Low-risk patients presenting with chest pain to diagnostic assessment with a cardiac panel measured by POCT or to diagnosis when biomarker measurement was based on central laboratory testing. Interventions 1125 patients were randomly assigned to POCT measurement of the triple marker panel of cardiac troponin I (cTnI), myoglobin and the MB isoenzyme of creatine kinase (CK-MB) on admission and 90 min from admission.
  
  
  METHODS
  Myocardial infarction (MI) was defined by the universal definition of MI. The following diagnostic strategies were compared by receiver operator characteristic (ROC) curve analysis and comparison of area under the curve (AUC): individual marker values, change (Δ) in CK-MB and myoglobin and the combination of presentation or 90 min value plus Δ value.
  
  
  RESULTS
  Admission sample measurement of cTnI was the most diagnostically efficient AUC 0.96 (0.93-0.98) with areas under the ROC curve statistically significantly greater than CK-MB 0.85 (0.80-0.90) and myoglobin 0.75 (0.68-0.81). At 90 min cTnI measurement had the highest AUC 0.95 (0.87-1.00) but was statistically significantly different only from Δmyoglobin and ΔCK-MB.
  
  
  CONCLUSIONS
  Measurement of cTnI alone is sufficient for diagnosis. Measurement of a marker panel does not facilitate diagnosis.
authors.affiliation: Department of Clinical Blood Sciences, St George's Hospital, Ground Floor, Jenner Wing, London SW17 0QT, UK. paul.collinson@stgeorges.nhs.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Collinson
authors.forename: Steve
authors.initials: S
authors.lastname: Goodacre
authors.forename: David
authors.initials: D
authors.lastname: Gaze
authors.forename: Alasdair
authors.initials: A
authors.lastname: Gray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D052279:Creatine Kinase, MB Form / Q000097:blood*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D052279:Creatine Kinase, MB Form