RT Journal Article
SR Electronic
T1 Multicentre evaluation of the diagnostic value of cardiac troponin T, CK-MB mass, and myoglobin for assessing patients with suspected acute coronary syndromes in routine clinical practice
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 280
OP 286
DO 10.1136/heart.89.3.280
VO 89
IS 3
A1 Collinson, P O
A1 Stubbs, P J
A1 Kessler, A-C
YR 2003
UL http://heart.bmj.com/content/89/3/280.abstract
AB Objective: To assess the diagnostic efficiency of the third generation cardiac troponin T assay in routine clinical practice. Design: Prospective observational study of unselected consecutive admissions. Setting: Multicentre study in 43 teaching and non-teaching hospitals in 13 countries. Subjects: 1105 hospital admissions, median age 67 years (range 15–96 years, 63.7% male) with suspected acute coronary syndromes (72.3% of cases) or other non-specific symptoms where cardiac disease required exclusion (27.7%). Interventions: Over the study period, myoglobin, creatine kinase MB isoenzyme (CK-MB), and cardiac troponin T where measured in parallel with conventional diagnostic tests. Final diagnostic classification involved standard ECG changes and CK-MB mass exceeding 5.0 μg/l. Main outcome measures: Diagnostic efficiency was assessed by receiver operator characteristic curve analysis including and excluding patients with unstable angina. Results: Measurement of cardiac troponin T was diagnostically equivalent to CK-MB and both were better than myoglobin, with areas under the curve at 12 hours of 0.94, 0.99, and 0.80, respectively. Diagnostic criteria using CK-MB were inadequate and showed bias when patients with unstable angina were included. Elevations of cardiac troponin T did not occur when cardiac disease could be categorically excluded but were found in clinical conditions other than suspected acute coronary syndromes. Conclusions: CK-MB is unsuitable as a diagnostic gold standard even at the proposed lower threshold. A lower cut off for cardiac troponin T of 0.05 μg/l should be used for diagnosis of acute myocardial infarction. Diagnosis of acute myocardial infarction cannot be made solely on the basis of a cardiac troponin T result.