What question did this study set out to answer?

To evaluate the effectiveness of a rapid point-of-care multimarker protocol for diagnosing acute myocardial infarction in chest pain patients.

April 21, 2008American Journal of Clinical PathologyOpen Access

A Rapid Point-of-Care Cardiac Marker Testing Strategy Facilitates the Rapid Diagnosis and Management of Chest Pain Patients in the Emergency Department

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Chest pain (n=5244). Intervention: Rapid, point-of-care multimarker protocol vs. Single and serial troponin I (TnI)-only protocol. Primary outcome: Diagnosis of acute myocardial infarction (AMI).

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Key result

A rapid point-of-care multimarker protocol achieved 99.7% overall diagnostic accuracy for acute myocardial infarction, appearing superior to a troponin I-only approach (sensitivity 68.2%).

Why the study?

Does a rapid point-of-care multimarker protocol improve diagnostic accuracy for acute myocardial infarction compared to a TnI-only protocol in patients admitted to the emergency department with chest pain?

Population

5,244 patients admitted to the emergency department with chest pain

Comparison

Rapid, point-of-care multimarker protocol vs Single and serial troponin I (TnI)-only protocol

Design

Cohort

Authors

ASAngela L. StrafaceArlington Center for Dermatology JMJohn H MyersBaylor College of Medicine HKHOWARD J. KIRCHICKAlere (United States)

Discussion

Member takes

Implication

Supports multimarker protocols for ED AMI diagnosis; hypothesis-generating and should not yet change troponin-based practice.

Key Points

To evaluate the effectiveness of a rapid point-of-care multimarker protocol for diagnosing acute myocardial infarction in chest pain patients.
Compared rapid multimarker protocol to troponin I-only protocol in 5,244 emergency department patients with chest pain.
Used new diagnostic criteria with myoglobin and creatine kinase levels for AMI confirmation.
Calculated positive predictive value, negative predictive value, and overall diagnostic accuracy.
145 of 148 AMI cases were positive using the new protocol (PPV 92.4%).
Negative predictive value was 99.9%, with overall diagnostic accuracy of 99.7%.
Troponin I-only protocol had a sensitivity of 68.2% and a lower NPV of 99.1%.

Study Design

Type

Observational (n=5,244)

Structured PICO

Population

5,244 patients admitted to the emergency department with chest pain.

Exposure

Rapid, point-of-care multimarker protocol (myoglobin, CK-MB, and TnI)

Comparator

Single and serial troponin I (TnI)-only protocol

Outcome

Diagnostic accuracy for acute myocardial infarction (AMI)surrogate

A rapid point-of-care multimarker protocol provides superior diagnostic accuracy for acute myocardial infarction compared to a TnI-only approach in emergency department patients with chest pain.

Cite This Study

Straface et al. (2008) conducted an observational in Chest pain (n=5,244). Rapid, point-of-care multimarker protocol vs. Single and serial troponin I (TnI)-only protocol was evaluated on Diagnosis of acute myocardial infarction (AMI). A rapid point-of-care multimarker protocol achieved 99.7% overall diagnostic accuracy for acute myocardial infarction, appearing superior to a troponin I-only approach (sensitivity 68.2%).

synapsesocial.com/papers/6a2007cd2065d284090dd534 https://doi.org/10.1309/9ggnmurljwjd88w3

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A Rapid Point-of-Care Cardiac Marker Testing Strategy Facilitates the Rapid Diagnosis and Management of Chest Pain Patients in the Emergency Department

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

A Rapid Point-of-Care Cardiac Marker Testing Strategy Facilitates the Rapid Diagnosis and Management of Chest Pain Patients in the Emergency Department

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider