December 27th, 2011
Possible Role for New Troponin Test to Diagnose MI
A new study from Germany provides evidence that a new high-sensitive troponin I (hsTnI) assay may improve and speed the early diagnosis of acute MI. In an article published in JAMA, Till Keller and colleagues report on 1818 patients with acute chest pain in whom numerous biomarker tests were conducted at admission and at 3 and 6 hours after admission. They compared the diagnostic performance of hsTnI with that of contemporary troponin I and other biomarkers.
The hsTnI assay provided more diagnostic information than contemporary TnI, as measured by the area under the receiver operating characteristic (ROC) curve on admission:
- 0.96 (95% CI, 0.95-0.97) for hsTnI, versus 0.92 for contemporary TnI (95% CI, 0.90-0.94); P<.001
As anticipated, the hsTnI was better than contemporary TnI in detecting lower concentrations of troponin I and in the first hours after the onset of chest pain. Both troponin tests were superior to the other biomarkers that were included in the study.
The authors examined various time points and cutoffs for “rule-out MI.” The highest negative predictive value, 99.6%, was provided by hsTnI at 3 hours after admission using the 99th-percentile cutoff. The authors commented that their results suggest that “ruling out MI appears feasible as early as 3 hours after admission in a large proportion of patients with chest pain.”
For “rule-in MI,” the relative change in hsTnI within 3 hours after admission, in addition to the 99th-percentile cutoff, provided the highest positive predictive value: 96.5%.