title: Quantitative point-of-care troponin T measurement for diagnosis and prognosis in patients with a suspected acute myocardial infarction.
abstract: Improvement of prehospital triage is essential to ensure rapid management of patients with acute myocardial infarction (AMI). This study evaluates the feasibility of prehospital quantitative point-of-care cardiac troponin T (POC-cTnT) analysis, its ability to identify patients with AMI, and its capacity to predict mortality. The study was performed in the Central Denmark Region from May 2010 to May 2011. As a supplement to electrocardiography, a prehospital POC-cTnT measurement was performed by a paramedic in patients with suspected AMI. AMI was diagnosed according to the universal definition of myocardial infarction using the ninety-ninth percentile upper reference level as diagnostic cut point. The paramedics performed POC-cTnT measurements in 985 subjects with a symptom duration of 70 minutes (95% CI, 35 to 180); of whom, 200 (20%) had an AMI. The prehospital sample was obtained 88 minutes (range, 58 to 131) before the sample made on admission to the hospital. The sensitivity for detection of patients with an AMI was 39% (95% CI, 32% to 46%) and the diagnostic accuracy of the POC-cTnT values was 0.67 (95% CI, 0.64 to 0.71). Adjusted survival analysis showed a strong significant association between elevated prehospital POC-cTnT level above the detection level of 50 ng/L and mortality in patients with a suspected AMI irrespective of whether an AMI was diagnosed. In conclusion, large-scale quantitative prehospital POC-cTnT testing by paramedics is feasible. An elevated prehospital POC-cTnT value contains diagnostic information and is highly predictive of mortality in patients with a suspected AMI.
authors: Department of Cardiology, Aarhus University Hospital, Aarhus, Central Denmark Region, Denmark. Electronic address: carstengaard@hotmail.com.
authors: Carsten
authors: C
authors: Stengaard
authors: Jacob Thorsted
authors: JT
authors: Sørensen
authors: Søren Andreas
authors: SA
authors: Ladefoged
authors: Erika Frischknecht
authors: EF
authors: Christensen
authors: Jens Flensted
authors: JF
authors: Lassen
authors: Hans Erik
authors: HE
authors: Bøtker
authors: Christian Juhl
authors: CJ
authors: Terkelsen
authors: Kristian
authors: K
authors: Thygesen
mesh_terms: D003718:Denmark / Q000453:epidemiology; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D004562:Electrocardiography; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T