Bedside Testing of Cardiac Troponin T and Myoglobin for the Detection of Acute Myocardial Infarction in Patients with a Nondiagnostic Electrocardiogram in the Emergency Department

Abstract: The authors report a multicenter study on the diagnosticefficiency of 2 point-of-care tests for troponin T and myoglobin inpatients with nondiagnostic electrocardiogram (EKG). A total of 341consecutive patients with a final diagnosis of acute myocardialinfarction admitted to 5 hospitals were included in the study, 172 ofwhom had no detectable ST-segment elevation or Q-wave change inany of their EKGs performed during the first 4 hours after presen-tation. Troponin T and myoglobin were quantitatively determinedon a point-of-care system in whole blood samples drawn onadmission, and 1, 2, and 4 hours later. During the first 4 hours afterpresentation, the troponin T test used alone achieved a sensitivity of75to94%,andcombiningbothtestsimprovedsensitivitybyafurther4 to 16%. Four hours after presentation both tests were negative inonly 3 acute myocardial infarction patients (2%). These diagnosticsensitivities for acute myocardial infarction in patients with a non-diagnostic EKG were comparable with those patients with a di-agnostic EKG.Key Words: point-of-care testing, troponin T, myoglobin, acutemyocardial infarction, nondiagnostic EKG(Point of Care 2004;3:159–161)

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