Time-dependent diagnostic performance of a rapid troponin T version 2 bedside test in patients with acute coronary syndromes.

In a prospective trial, the diagnostic performance of the second version of the troponin T rapid assay (Trop T; cutoff 0.2 microg/L) was compared with the quantitative cardiac-specific troponin T assay (cTnT ELISA; cutoff 0.1 microg/L) and other established cardiac markers such as CK, CK-MB activity, CK-MB mass and myoglobin. Additionally, a 30-day follow-up was performed to determine the suitability of the Trop T assay and the reference markers for short-term risk stratification. Two-hundred-and-eighty-six consecutive patients with chest pain and suspected acute myocardial infarction (AMI) were enrolled in two CCU departments. Serial blood specimens were taken at admission and at 3, 6, 12, 24, 48, 72 and 96 h after admission. According to the biochemical criterion CK-MB mass, the patients were classified as having AMI in 154 patients (54%), unstable angina (UAP) in 72 patients (27%) and no evidence for acute cardiac ischemia in 55 patients (19%). Analytical method comparison of Trop T with cTnT ELISA (cutoff 0.1 microg/L) showed a good agreement, Trop T yielded only 4% false-negative and 3% false-positive results. The diagnostic performance of Trop T for the detection of AMI was only slightly inferior compared to cTnT ELISA. Beyond 12 h after admission, Trop T and cTnT ELISA maintained a sensitivity close to 100%, whereas the sensitivity of the other cardiac markers decreased sharply. The diagnostic sensitivity of Trop T for the detection of minor myocardial damage in UAP patients was the same as for cTnT ELISA. Death within 30 days' follow-up occurred only in AMI patients with a positive Trop T test result within the first 6 h after admission. The admission Trop T and cTnT ELISA were the only significant biochemical predictors of major cardiac events. In conclusion, these data show that Trop T has similar diagnostic sensitivity as cTnT ELISA and is a useful tool to confirm acute or subacute myocardial infarction. Trop T is an excellent marker in detecting minor myocardial damage in UAP patients and is suitable for short-term risk stratification.

[1]  T. Groth,et al.  The value of serum myoglobin determinations in the early diagnosis of acute myocardial infarction. , 2009, Acta medica Scandinavica.

[2]  R. Califf,et al.  Minimal myocardial damage during coronary intervention is associated with impaired outcome. , 1999, European heart journal.

[3]  A. Remppis,et al.  Quantitative bedside assay for cardiac troponin T: a complementary method to centralized laboratory testing. , 1999, Clinical chemistry.

[4]  C. Defilippi,et al.  Diagnostic accuracy, angiographic correlates and long-term risk stratification with the troponin T ultra sensitive Rapid Assay in chest pain patients at low risk for acute myocardial infarction. , 1998, European heart journal.

[5]  D. Waters,et al.  Prognostic role of troponin T versus troponin I in unstable angina pectoris for cardiac events with meta-analysis comparing published studies. , 1998, The American journal of cardiology.

[6]  G. Kost,et al.  A strategy for the use of cardiac injury markers (troponin I and T, creatine kinase-MB mass and isoforms, and myoglobin) in the diagnosis of acute myocardial infarction. , 1998, Archives of pathology & laboratory medicine.

[7]  C. Heeschen,et al.  Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. , 1997, The New England journal of medicine.

[8]  C. Lovis,et al.  An improved rapid troponin T test with a decreased detection limit: a multicentre study of the analytical and clinical performance in suspected myocardial damage. , 1997, Scandinavian journal of clinical and laboratory investigation.

[9]  M. Kollef,et al.  Clinically recognized cardiac dysfunction: an independent determinant of mortality among critically ill patients. Is there a role for serial measurement of cardiac troponin I? , 1997, Chest.

[10]  A. Remppis,et al.  Improved troponin T ELISA specific for cardiac troponin T isoform: assay development and analytical and clinical validation. , 1997, Clinical chemistry.

[11]  D Wybenga,et al.  Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. , 1996, The New England journal of medicine.

[12]  F. Harrell,et al.  Cardiac Troponin T Levels for Risk Stratification in Acute Myocardial Ischemia , 1996 .

[13]  M. Noble,et al.  Prognostic significance of admission troponin T concentrations in patients with myocardial infarction. , 1996, Circulation.

[14]  L. Wallentin,et al.  Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease. The FRISC study group. , 1996, Circulation.

[15]  PerVenge,et al.  Relation Between Troponin T and the Risk of Subsequent Cardiac Events in Unstable Coronary Artery Disease , 1996 .

[16]  D. Waters,et al.  Prognostic value of cardiac troponin I in patients with chest pain. , 1996, Clinical chemistry.

[17]  E. Schaefer,et al.  Implementation of recommendations from the NCEP working group on lipoprotein measurement. , 1996, Clinical chemistry.

[18]  J H Keffer,et al.  Myocardial markers of injury. Evolution and insights. , 1996, American journal of clinical pathology.

[19]  R. D. de Winter,et al.  Value of myoglobin, troponin T, and CK-MBmass in ruling out an acute myocardial infarction in the emergency room. , 1995, Circulation.

[20]  A. Remppis,et al.  Development and characterization of a rapid assay for bedside determinations of cardiac troponin T. , 1995, Circulation.

[21]  T. Kircher,et al.  Myoglobin in the early evaluation of acute chest pain. , 1995, American journal of clinical pathology.

[22]  J. Mccabe,et al.  Is myoglobin useful in the diagnosis of acute myocardial infarction in the emergency department setting? , 1995, American journal of clinical pathology.

[23]  E. Antman,et al.  Evaluation of a rapid bedside assay for detection of serum cardiac troponin T. , 1995, JAMA.

[24]  C. Lovis,et al.  Rapid bedside whole blood cardiospecific troponin T immunoassay for the diagnosis of acute myocardial infarction. , 1995, The American journal of cardiology.

[25]  H. Thode,et al.  Evaluation of a new rapid quantitative immunoassay for serum myoglobin versus CK-MB for ruling out acute myocardial infarction in the emergency department. , 1994, Annals of emergency medicine.

[26]  R. Collins,et al.  Value of serial myoglobin levels in the early diagnosis of patients admitted for acute myocardial infarction. , 1994, Annals of emergency medicine.

[27]  J. Zimmerman,et al.  Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction. , 1994, The New England journal of medicine.

[28]  A. Wu,et al.  Cardiac troponin-T immunoassay for diagnosis of acute myocardial infarction. , 1994, Clinical chemistry.

[29]  M. Zaninotto,et al.  Troponin T as a marker of ischemic myocardial injury. , 1994, Clinical biochemistry.

[30]  J. Ravkilde,et al.  Diagnostic performance and prognostic value of serum troponin T in suspected acute myocardial infarction. , 1993, Scandinavian journal of clinical and laboratory investigation.

[31]  W S Kilpatrick,et al.  Early Diagnosis of Acute Myocardial Infarction: CK-MB and Myoglobin Compared , 1993, Annals of clinical biochemistry.

[32]  Collinson Po,et al.  The prognostic value of serum troponin T in unstable angina. , 1992 .

[33]  J. Mair,et al.  Early diagnosis of acute myocardial infarction by a newly developed rapid immunoturbidimetric assay for myoglobin , 1992, British heart journal.

[34]  J. Mair,et al.  Cardiac troponin T in diagnosis of acute myocardial infarction. , 1991, Clinical chemistry.

[35]  A. Remppis,et al.  Diagnostic Efficiency of Troponin T Measurements in Acute Myocardial Infarction , 1991, Circulation.

[36]  A. Timmis,et al.  Early diagnosis of acute myocardial infarction. , 1990, BMJ.

[37]  R Roberts,et al.  Early diagnosis of acute myocardial infarction based on assay for subforms of creatine kinase-MB. , 1990, Circulation.

[38]  M. Ohman,et al.  Early detection of acute myocardial infarction: additional diagnostic information from serum concentrations of myoglobin in patients without ST elevation. , 1990, British heart journal.

[39]  A. Remppis,et al.  Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients. , 1989, Journal of molecular and cellular cardiology.

[40]  R. Roberts,et al.  Sensitive, rapid assay of subforms of creatine kinase MB in plasma. , 1989, Clinical chemistry.

[41]  W. Gibler,et al.  Myoglobin as an early indicator of acute myocardial infarction. , 1987, Annals of emergency medicine.

[42]  L. Kahana,et al.  The roles of serum myoglobin, total CPK, and CK-MB isoenzyme in the acute phase of myocardial infarction. , 1983, American heart journal.

[43]  M. Plebani,et al.  Diagnostic strategies in myocardial infarction using myoglobin measurement. , 1998, European heart journal.

[44]  F. Van de Werf,et al.  Thrombolysis-induced coronary reperfusion causes acute and massive interstitial release of cardiac muscle cell proteins. , 1997, Cardiovascular research.

[45]  A. Castaldo,et al.  Plasma Myoglobin in the Early Diagnosis of Acute Myocardial Infarction , 1994, European journal of clinical chemistry and clinical biochemistry : journal of the Forum of European Clinical Chemistry Societies.

[46]  W. Gerhardt,et al.  Rational diagnostic strategy in diagnosis of ischemic myocardial injury. S-troponin T and S-CK MB (mass) time series using individual baseline values. , 1993, Scandinavian journal of clinical and laboratory investigation. Supplementum.

[47]  J. Mair,et al.  Cardiac troponin T in the diagnosis of myocardial injury. , 1992, Critical reviews in clinical laboratory sciences.

[48]  P. Stubbs,et al.  The prognostic value of serum troponin T in unstable angina. , 1992, The New England journal of medicine.

[49]  Nomenclature and criteria for diagnosis of ischemic heart disease. Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature. , 1979, Circulation.

[50]  R. Galen,et al.  Beyond Normality: The Predictive Value and E ciency of Medical Diagnoses , 1975 .