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
Open Access
- 1 March 2003
- Vol. 89 (3) , 280-286
- https://doi.org/10.1136/heart.89.3.280
Abstract
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.Keywords
This publication has 40 references indexed in Scilit:
- Myocardial infarction redefined—A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial InfarctionEuropean Heart Journal, 2000
- Management of acute coronary syndromes: acute coronary syndromes without persistent ST segment elevation. Recommendations of the Task Force of the European Society of Cardiology Recommendations of the Task Force of the European Society of CardiologyEuropean Heart Journal, 2000
- Science of urinary incontinenceThe Lancet, 1994
- Cardiac troponin T release in acute myocardial infarction is associated with scintigraphic estimates of myocardial scarCoronary Artery Disease, 1993
- Early detection of acute myocardial infarction by measurement of mass concentration of creatine kinase-MBThe American Journal of Cardiology, 1991
- Use of the Initial Electrocardiogram to Predict In-Hospital Complications of Acute Myocardial InfarctionNew England Journal of Medicine, 1985
- The Value of Serum Myoglobin Determinations in the Early Diagnosis of Acute Myocardial InfarctionActa Medica Scandinavica, 1984
- Assessment of the accuracy of serial electrocardiograms in the diagnosis of myocardial infarctionAmerican Heart Journal, 1983
- 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.Circulation, 1979
- Radioimmunoassays of human myoglobin in serum and urineScandinavian Journal of Clinical and Laboratory Investigation, 1979