Michelle Welsford, MD, ABEM
In patients presenting to the emergency department (ED) with chest pain, how accurate are sensitive cardiac troponin assays compared with a standard troponin assay for early diagnosis of acute myocardial infarction (AMI)?
Blinded comparison of 5 cardiac troponin assays with final clinical diagnosis (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] study). ClinicalTrials.gov NCT00470587.
6 EDs in Switzerland and Spain.
718 patients (mean age 64 y, 66% men) who presented to the ED within 12 hours of onset of symptoms suggestive of AMI (chest pain and angina pectoris). Patients on dialysis were excluded.
4 sensitive cardiac troponin assays (Abbott-Architect Troponin I, Roche High-Sensitive Troponin T, Roche Troponin I, and Siemens Troponin I Ultra) and a standard troponin assay (Roche Troponin T, fourth generation).
Final clinical diagnosis by 2 independent cardiologists using all available information at ≤ 60 days (except the study tests).
Sensitivity, specificity, positive and negative likelihood ratios, and area under the receiver-operating characteristic curve for each test.
The 4 sensitive troponin assays were more accurate than the standard troponin assay (Table), especially in patients who presented within 3 hours of onset of symptoms. The sensitive tests were similarly accurate for ST-segment elevation AMI and non–ST-segment elevation AMI.
In patients presenting to the emergency department with chest pain, sensitive cardiac troponin assays were more accurate than a standard troponin assay for early diagnosis of acute myocardial infarction.
4 sensitive cardiac troponin assays vs a standard troponin assay for early diagnosis of acute myocardial infarction in the emergency department*
*ROC = receiver-operating characteristic; diagnostic terms and CI defined in Glossary. LRs calculated from sensitivity and specificity in article. The gold standard was final clinical diagnosis at 60 days.
†At 99th percentile.
‡At 10% coefficient of variation.
Welsford M. Sensitive cardiac troponin assays were more accurate than a standard troponin assay for early diagnosis of AMI. Ann Intern Med. ;151:JC6–12. doi: 10.7326/0003-4819-151-12-200912150-02012
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Published: Ann Intern Med. 2009;151(12):JC6-12.
Cardiac Diagnosis and Imaging, Cardiology.
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