• P O Collinson, P J Stubbs, A-C Kessler, and Multicentre Evaluation Of Routine Immunoassay Of Troponin T Study.
• Department of Chemical Pathology, St George's Hospital, London, UK. paul.collinson@stgeorges.nhs.uk
• Heart. 2003 Mar 1;89(3):280-6.

ObjectiveTo assess the diagnostic efficiency of the third generation cardiac troponin T assay in routine clinical practice.DesignProspective observational study of unselected consecutive admissions.SettingMulticentre study in 43 teaching and non-teaching hospitals in 13 countries.Subjects1105 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%).InterventionsOver 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 microg/l.Main Outcome MeasuresDiagnostic efficiency was assessed by receiver operator characteristic curve analysis including and excluding patients with unstable angina.ResultsMeasurement 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.ConclusionsCK-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 microg/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.

38 keywords...

hide…