Key result
The 3rd generation cTnT assay classified 35% more patients as having acute myocardial infarction on admission and identified a 10% larger low-risk group compared to the 2nd generation assay.
Why the study?
Does the 3rd generation cTnT assay improve diagnostic classification and risk stratification compared to the 2nd generation assay in patients with suspected ACS without ST elevation?
Observational (n=750)
No
Does the 3rd generation cTnT assay improve diagnostic classification and risk stratification compared to the 2nd generation assay in patients with suspected ACS without ST elevation?
The 3rd generation cTnT assay offers improved precision over the 2nd generation assay, leading to more sensitive detection of myocardial infarction and better risk stratification in patients with chest pain.
May refine ACS triage via better classification; hypothesis-generating and should not yet change practice.
Cardiac troponin T (cTnT) is a useful tool when assessing patients with chest pain and no persistent ST elevation. We compared the 2nd generation with the new, 3rd generation cTnT assay in 750 patients admitted to our coronary care unit because of chest pain. When focusing on patients with cTnT of 0.01-0.20 microg/l, there was a moderate agreement between the methods. According to recent definitions, 35% more patients were classified as having acute myocardial infarction on admission with the 3rd generation assay. The 3rd generation assay also identified a 10% larger low-risk group and was better able to identify patients with signs of very minor myocardial necrosis (cTnT >0.01-0.02 microg/l) and thereby an increased risk of future events. We conclude that the improved precision of the 3rd generation assay does have some clinical implications in terms of improved accuracy of triage and improved prognostic value.
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Jernberg et al. (2003) conducted an observational in Acute Coronary Syndrome without ST Segment Elevation (n=750). 3rd generation cTnT assay vs. 2nd generation cTnT assay was evaluated on Classification of acute myocardial infarction on admission. The 3rd generation cTnT assay classified 35% more patients as having acute myocardial infarction on admission and identified a 10% larger low-risk group compared to the 2nd generation assay.
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