title: Can a Point-of-Care Troponin I Assay be as Good as a Central Laboratory Assay? A MIDAS Investigation.
abstract: BACKGROUND
  We aimed to compare the diagnostic accuracy of the Alere Triage Cardio3 Tropinin I (TnI) assay (Alere, Inc., USA) and the PathFast cTnI-II (Mitsubishi Chemical Medience Corporation, Japan) against the central laboratory assay Singulex Erenna TnI assay (Singulex, USA).
  
  
  METHODS
  Using the Markers in the Diagnosis of Acute Coronary Syndromes (MIDAS) study population, we evaluated the ability of three different assays to identify patients with acute myocardial infarction (AMI). The MIDAS dataset, described elsewhere, is a prospective multicenter dataset of emergency department (ED) patients with suspected acute coronary syndrome (ACS) and a planned objective myocardial perfusion evaluation. Myocardial infarction (MI) was diagnosed by central adjudication.
  
  
  RESULTS
  The C-statistic with 95% confidence intervals (CI) for diagnosing MI by using a common population (n=241) was 0.95 (0.91-0.99), 0.95 (0.91-0.99), and 0.93 (0.89-0.97) for the Triage, Singulex, and PathFast assays, respectively. Of samples with detectable troponin, the absolute values had high Pearson (R(P)) and Spearman (R(S)) correlations and were R(P)=0.94 and R(S)=0.94 for Triage vs Singulex, R(P)=0.93 and R(S)=0.85 for Triage vs PathFast, and R(P)=0.89 and R(S)=0.73 for PathFast vs Singulex.
  
  
  CONCLUSIONS
  In a single comparative population of ED patients with suspected ACS, the Triage Cardio3 TnI, PathFast, and Singulex TnI assays provided similar diagnostic performance for MI.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA. Frankpeacock@gmail.com.
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.affiliation: University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Diercks
authors.affiliation: New York Methodist Hospital, Brooklyn, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Birkhahn
authors.affiliation: Stony Brook University, Stony Brook, NY, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.affiliation: Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.affiliation: Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.affiliation: Yale University, New Haven, CT, USA.
authors.forename: Basmah
authors.initials: B
authors.lastname: Safdar
authors.affiliation: Wake Forest University, Winston-Salem, NC, USA.
authors.forename: Chadwick D
authors.initials: CD
authors.lastname: Miller
authors.affiliation: Virginia Commonwealth University Health Systems, Richmond, VA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Peberdy
authors.affiliation: Eastern Virginia Medical School, Norfolk, VA, USA.
authors.forename: Francis
authors.initials: F
authors.lastname: Counselman
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Chandra
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kosowsky
authors.affiliation: Genesis Healthcare System, Zanesville, OH, USA.
authors.forename: James
authors.initials: J
authors.lastname: Neuenschwander
authors.affiliation: Metrohealth Medical Center, Cleveland, OH, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Schrock
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lee-Lewandrowski
authors.affiliation: Alere, Inc., San Diego, CA, USA.
authors.forename: William
authors.initials: W
authors.lastname: Arnold
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Nagurney
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D004636:Emergency Service, Hospital; D006801:Humans; D007753:Laboratories / Q000592:standards; D009203:Myocardial Infarction / Q000175:diagnosis; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000032:analysis*
chemical_list: D015415:Biomarkers; D011933:Reagent Kits, Diagnostic; D019210:Troponin I
keywords: Diagnostic accuracy; Emergency medicine; Point-of-care; Troponin