Early diagnosis of myocardial infarction with sensitive cardiac troponin assays
Standard
Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. / Reichlin, Tobias; Hochholzer, Willibald; Bassetti, Stefano; Steuer, Stephan; Stelzig, Claudia; Hartwiger, Sabine; Biedert, Stefan; Schaub, Nora; Buerge, Christine; Potocki, Mihael; Noveanu, Markus; Breidthardt, Tobias; Twerenbold, Raphael; Winkler, Katrin; Bingisser, Roland; Mueller, Christian.
in: New England Journal of Medicine, Jahrgang 361, Nr. 9, 27.08.2009, S. 858-867.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Early diagnosis of myocardial infarction with sensitive cardiac troponin assays
AU - Reichlin, Tobias
AU - Hochholzer, Willibald
AU - Bassetti, Stefano
AU - Steuer, Stephan
AU - Stelzig, Claudia
AU - Hartwiger, Sabine
AU - Biedert, Stefan
AU - Schaub, Nora
AU - Buerge, Christine
AU - Potocki, Mihael
AU - Noveanu, Markus
AU - Breidthardt, Tobias
AU - Twerenbold, Raphael
AU - Winkler, Katrin
AU - Bingisser, Roland
AU - Mueller, Christian
PY - 2009/8/27
Y1 - 2009/8/27
N2 - BACKGROUND: The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need. METHODS: We conducted a multicenter study to examine the diagnostic accuracy of new, sensitive cardiac troponin assays performed on blood samples obtained in the emergency department from 718 consecutive patients who presented with symptoms suggestive of acute myocardial infarction. Cardiac troponin levels were determined in a blinded fashion with the use of four sensitive assays (Abbott-Architect Troponin I, Roche High-Sensitive Troponin T, Roche Troponin I, and Siemens Troponin I Ultra) and a standard assay (Roche Troponin T). The final diagnosis was adjudicated by two independent cardiologists. RESULTS: Acute myocardial infarction was the adjudicated final diagnosis in 123 patients (17%). The diagnostic accuracy of measurements obtained at presentation, as quantified by the area under the receiver-operating-characteristic curve (AUC), was significantly higher with the four sensitive cardiac troponin assays than with the standard assay (AUC for Abbott-Architect Troponin I, 0.96; 95% confidence interval [CI], 0.94 to 0.98; for Roche High-Sensitive Troponin T, 0.96; 95% CI, 0.94 to 0.98; for Roche Troponin I, 0.95; 95% CI, 0.92 to 0.97; and for Siemens Troponin I Ultra, 0.96; 95% CI, 0.94 to 0.98; vs. AUC for the standard assay, 0.90; 95% CI, 0.86 to 0.94). Among patients who presented within 3 hours after the onset of chest pain, the AUCs were 0.93 (95% CI, 0.88 to 0.99), 0.92 (95% CI, 0.87 to 0.97), 0.92 (95% CI, 0.86 to 0.99), and 0.94 (95% CI, 0.90 to 0.98) for the sensitive assays, respectively, and 0.76 (95% CI, 0.64 to 0.88) for the standard assay. We did not assess the effect of the sensitive troponin assays on clinical management. CONCLUSIONS: The diagnostic performance of sensitive cardiac troponin assays is excellent, and these assays can substantially improve the early diagnosis of acute myocardial infarction, particularly in patients with a recent onset of chest pain. (ClinicalTrials. gov number, NCT00470587.)
AB - BACKGROUND: The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need. METHODS: We conducted a multicenter study to examine the diagnostic accuracy of new, sensitive cardiac troponin assays performed on blood samples obtained in the emergency department from 718 consecutive patients who presented with symptoms suggestive of acute myocardial infarction. Cardiac troponin levels were determined in a blinded fashion with the use of four sensitive assays (Abbott-Architect Troponin I, Roche High-Sensitive Troponin T, Roche Troponin I, and Siemens Troponin I Ultra) and a standard assay (Roche Troponin T). The final diagnosis was adjudicated by two independent cardiologists. RESULTS: Acute myocardial infarction was the adjudicated final diagnosis in 123 patients (17%). The diagnostic accuracy of measurements obtained at presentation, as quantified by the area under the receiver-operating-characteristic curve (AUC), was significantly higher with the four sensitive cardiac troponin assays than with the standard assay (AUC for Abbott-Architect Troponin I, 0.96; 95% confidence interval [CI], 0.94 to 0.98; for Roche High-Sensitive Troponin T, 0.96; 95% CI, 0.94 to 0.98; for Roche Troponin I, 0.95; 95% CI, 0.92 to 0.97; and for Siemens Troponin I Ultra, 0.96; 95% CI, 0.94 to 0.98; vs. AUC for the standard assay, 0.90; 95% CI, 0.86 to 0.94). Among patients who presented within 3 hours after the onset of chest pain, the AUCs were 0.93 (95% CI, 0.88 to 0.99), 0.92 (95% CI, 0.87 to 0.97), 0.92 (95% CI, 0.86 to 0.99), and 0.94 (95% CI, 0.90 to 0.98) for the sensitive assays, respectively, and 0.76 (95% CI, 0.64 to 0.88) for the standard assay. We did not assess the effect of the sensitive troponin assays on clinical management. CONCLUSIONS: The diagnostic performance of sensitive cardiac troponin assays is excellent, and these assays can substantially improve the early diagnosis of acute myocardial infarction, particularly in patients with a recent onset of chest pain. (ClinicalTrials. gov number, NCT00470587.)
UR - http://www.scopus.com/inward/record.url?scp=69349099937&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa0900428
DO - 10.1056/NEJMoa0900428
M3 - SCORING: Journal article
C2 - 19710484
AN - SCOPUS:69349099937
VL - 361
SP - 858
EP - 867
JO - NEW ENGL J MED
JF - NEW ENGL J MED
SN - 0028-4793
IS - 9
ER -
