title: High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain.
abstract: BACKGROUND
  Measurement of high-sensitive cardiac troponin (hs-cTn) has facilitated the early diagnostic assessment of chest pain patients. However, the information obtained from hs-cTnT levels might be improved when combined with results of other biomarkers of myocardial injury.
  
  
  METHODS
  We measured admission levels of hs-cTnT (Roche Diagnostics), heart-type fatty-acid binding protein (H-FABP; Randox Laboratories) and copeptin using a novel ultra-sensitive (us) assay (Thermo Fisher Scientific) in 360 chest pain patients with a non-diagnostic ECG. Non-STEMI was defined according to the Universal Definition using cardiac troponin I (Stratus CS; Siemens Healthcare Diagnostics) as biochemical gold standard.
  
  
  RESULTS
  Non-STEMI was diagnosed in 128 (36%) patients. Hs-cTnT had a greater diagnostic accuracy regarding non-STEMI (C-statistics 0.84) compared to H-FABP (C-statistics 0.80; p=0.04) and us-copeptin C-statistics(0.62; p<0.001). Compared to hs-cTnT alone, no increase in the C-statistics was noted for the combination of hs-cTnT with H-FABP (0.85; p=0.43) or with us-copeptin (0.84; p=0.88). Due to suboptimal sensitivities and/or specificities, neither H-FABP nor us-copeptin dichotomized at commonly applied diagnostic thresholds added information to hs-cTnT that would have facilitated early diagnostic assessment.
  
  
  CONCLUSIONS
  Hs-cTnT provides an excellent early diagnostic accuracy regarding non-STEMI already on admission. Neither H-FABP nor us-copeptin perform better or provide diagnostic increment to hs-cTnT levels.
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden. kai.eggers@ucr.uu.se
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.forename: Per
authors.initials: P
authors.lastname: Venge
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T