Background: High-sensitivity troponin assays are now available for clinical use. We investigated whether early measurement with such an assay is superior to a conventional assay in the evaluation of acute coronary syndromes. Methods: Patients presenting to an emergency department with chest pain who did not have ST-segment elevation were prospectively recruited from November 2007 to December 2010. Patients underwent serial testing with a conventional cardiac troponin I assay. Samples were also obtained at presentation and two hours later for measurement of troponin T levels using a high-sensitivity assay. The primary outcome was diagnosis of myocardial infarction on admission; secondary outcomes were death, myocardial infarction and heart failure at one year. Results: Of the 939 patients enrolled in the study, 205 (21.8%) had myocardial infarction. By two hours after presentation, the high-sensitivity troponin T assay at the cut-off point of the 99th percentile of the general population (14 ng/L) had a sensitivity of 92.2% (95% confidence interval [CI] 88.1%-95.0%) and a specificity of 79.7% (95% CI 78.6%-80.5%) for the diagnosis of non-ST-segment myocardial infarction. The sensitivity of the assay at presentation was 100% among patients who presented four to six hours after symptom onset. By one year, the high-sensitivity troponin T assay was found to be superior than the conventional assay in predicting death (hazard ratio [HR] 5.4, 95% CI 2.7-10.7) and heart failure (HR 27.8, 95% CI 6.6-116.4), whereas the conventional assay was superior in predicting non fatal myocardial infarction (HR 4.0, 95% CI 2.4-6.7). Interpretation: The high-sensitivity troponin T assay at the cut-off point of the 99th percentile was highly sensitive for the diagnosis of myocardial infarction by two hours after presentation and had prognostic utility be yond that of the conventional assay. To rule out myocardial infarction, the optimal time to test a second sample using the high-sensitivity troponin T level may be four to six hours after symptom onset, but this finding needs verification in future studies before it can become routine practice.
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SAHMRI, Hlth Syst Res, Adelaide, SA, AustraliaFlinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia
Horsfall, Matthew
Astley, Carolyn
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Flinders Univ S Australia, Adelaide, SA, Australia
Heart Fdn, Adelaide, SA, AustraliaFlinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia
Astley, Carolyn
Karnon, Jonathan
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SA Hlth Adelaide, SA Pathol, Adelaide, SA, AustraliaFlinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia
Karnon, Jonathan
Coates, Penelope
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Univ Adelaide, Adelaide, SA, AustraliaFlinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia
Coates, Penelope
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Arstall, Margaret
Zeitz, Christopher
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Univ Adelaide, Adelaide, SA, AustraliaFlinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia
Zeitz, Christopher
Worthley, Matthew
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Univ Adelaide, Adelaide, SA, AustraliaFlinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia
Worthley, Matthew
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Beltrame, John
Chew, Derek P.
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Flinders Med Ctr, Flinders Dr, Bedford Pk, SA, AustraliaFlinders Univ S Australia, Hlth Econ Unit, Adelaide, SA, Australia
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Kleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Westwood, Marie E.
Armstrong, Nigel
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Kleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Armstrong, Nigel
Worthy, Gill
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Kleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Worthy, Gill
Fayter, Debra
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Kleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Fayter, Debra
Ramaekers, Bram L. T.
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Maastricht Univ, Dept Clin Epidemiol & Med Technol Assessment, Med Ctr, Maastricht, NetherlandsKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Ramaekers, Bram L. T.
Grimm, Sabine
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Maastricht Univ, Dept Clin Epidemiol & Med Technol Assessment, Med Ctr, Maastricht, NetherlandsKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Grimm, Sabine
Buksnys, Titas
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Kleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Buksnys, Titas
Ross, Janine
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Kleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Ross, Janine
Mills, Nicholas L.
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Univ Edinburgh, BHF Univ Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, ScotlandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Mills, Nicholas L.
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Body, Richard
Collinson, Paul O.
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St Georges Univ Hosp NHS Fdn Trust, Dept Clin Blood Sci, London, England
St Georges Univ London, London, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Collinson, Paul O.
Timmis, Adam
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Queen Mary Univ, Barts Heart Ctr, London, EnglandKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Timmis, Adam
Kleijnen, Jos
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Kleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England
Maastricht Univ, Sch Publ Hlth & Primary Care CAPHRI, Maastricht, NetherlandsKleijnen Systemat Reviews Ltd, Unit 6,Escrick Business Pk,Riccall Rd, York YO19 6FD, N Yorkshire, England