What question did this study set out to answer?

To evaluate the diagnostic efficiency of a point-of-care triple biomarker panel compared with cardiac troponin I alone for assessing emergency department chest pain.

November 10, 2011Heart

Very early diagnosis of chest pain by point-of-care testing: comparison of the diagnostic efficiency of a panel of cardiac biomarkers compared with troponin measurement alone in the RATPAC trial

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Why the study?

Does point-of-care testing with a triple marker panel improve diagnostic efficiency for myocardial infarction compared to troponin measurement alone in low-risk patients presenting with chest pain?

Population

1125 low-risk patients presenting with chest pain to diagnostic assessment in six emergency departments

Comparison

Point-of-care testing measurement of a triple… vs Biomarker measurement based on central…

Design

RCT, randomly assigned

Follow-up

90 min from admission

Authors

PCPaul CollinsonGeneral / Preventive / Lipids SGSteve GoodacreUppsala University DGDavid GazeCardiac Imaging

Discussion

Member takes

Implication

Admission cTnI alone suffices for MI diagnosis in low-risk ED chest pain; confirms no added value from CK-MB or myoglobin panels.

Key Points

To evaluate the diagnostic efficiency of a point-of-care triple biomarker panel compared with cardiac troponin I alone for assessing emergency department chest pain.
Multicenter randomized trial across six emergency departments involving 1125 low-risk patients presenting with acute chest pain.
Patients underwent point-of-care testing for cardiac troponin I (cTnI), CK-MB, and myoglobin at baseline and 90 minutes, with diagnostic accuracy evaluated by receiver operating characteristic (ROC) area under the curve (AUC) for myocardial infarction.
At admission, cTnI alone demonstrated the highest diagnostic accuracy with an AUC of 0.96 (95% CI, 0.93 to 0.98), significantly outperforming CK-MB (AUC 0.85; 95% CI, 0.80 to 0.90) and myoglobin (AUC 0.75; 95% CI, 0.68 to 0.81).
At 90 minutes post-admission, cTnI maintained superior diagnostic accuracy (AUC 0.95; 95% CI, 0.87 to 1.00), differing significantly from change in myoglobin and change in CK-MB.

Structured PICO

Does point-of-care testing with a triple marker panel improve diagnostic efficiency for myocardial infarction compared to troponin measurement alone in low-risk patients presenting with chest pain?

Population

1125 low-risk patients presenting with chest pain to diagnostic assessment in six emergency departments

Intervention

Point-of-care testing (POCT) measurement of a triple marker panel of cardiac troponin I (cTnI), myoglobin, and the MB isoenzyme of creatine kinase (CK-MB) on admission and 90 min from admission

Comparator

Biomarker measurement based on central laboratory testing, and comparison of diagnostic efficiency against troponin measurement alone

Outcome

Diagnostic efficiency for myocardial infarction (MI) assessed by receiver operator characteristic (ROC) curve analysis and area under the curve (AUC)surrogate

In low-risk patients presenting with chest pain, measurement of cardiac troponin I alone is sufficient for the diagnosis of myocardial infarction, and adding myoglobin and CK-MB does not improve diagnostic efficiency.

Cite This Study

Collinson et al. (2011) studied this question.

synapsesocial.com/papers/6a7163068031ec7bb1dcf058 https://doi.org/10.1136/heartjnl-2011-300723

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Very early diagnosis of chest pain by point-of-care testing: comparison of the diagnostic efficiency of a panel of cardiac biomarkers compared with troponin measurement alone in the RATPAC trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Very early diagnosis of chest pain by point-of-care testing: comparison of the diagnostic efficiency of a panel of cardiac biomarkers compared with troponin measurement alone in the RATPAC trial

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

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