Early diagnosis of myocardial infarction

The rapid and reliable diagnosis of acute myocardial infarction is a major unmet clinical need. 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 concentrations 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. 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 greater with the four sensitive cardiac troponin assays than with the standard assay (AUC values: Abbott-Architect Troponin I, 0.96, 95% confidence interval [CI] 0.94 to 0.98; Roche High-Sensitive Troponin T, 0.96, 95% CI 0.94 to 0.98; Roche Troponin I, 0.95, 95% CI 0.92 to 0.97; Siemens Troponin I Ultra, 0.96, 95% CI 0.94 to 0.98; standard assay, 0.90, 95% CI 0.86 to 0.94). Among patients who presented within 3 h 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