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Elliott M. Antman, MD; Christine Grudzien, MS, MT; David B. Sacks, MB, ChB

JAMA. 1995;273(16):1279-1282.

Abstract
Objective.
—To evaluate a rapid, qualitative, bedside immunoassay for cardiac-specific troponin T (cTnT) using a handheld device containing monoclonal antibodies.

Design.
—Comparison of rapid cTnT assay with clinical standard for diagnosis of myocardial infarction (Ml).

Setting.
—Tertiary care university medical center.

Patients.
—A cohort of 100 patients admitted for evaluation of chest pain who had sufficient blood samples at presentation for measurement of creatine kinase, creatine kinase MB fraction, and rapid cTnT as well as adequate clinical data to establish the diagnosis of Ml.

Intervention.
—None; treating physicians were blinded to rapid cTnT results.

Main Outcome Measures.
—Sensitivity and specificity of rapid cTnT assay for Ml; likelihood ratios of positive and negative rapid cTnT assay results; relative risk (RR) for serious cardiac events with positive rapid cTnT assay result on admission.

Results.
—Sensitivity of the rapid cTnT assay increased from 33% within 2 hours from the onset of chest pain to 86% after 8 hours (P<.001); specificity ranged from 86% to 100% during the same time intervals. The odds of an Ml increased sixfold with a positive assay result within 2 hours of chest pain and decreased sixfold with a negative assay result after 8 hours. The RR for experiencing death or nonfatal Ml was 6.8 for patients presenting with a positive rapid cTnT assay.

Conclusions.
—The rapid cTnT assay is a simple, efficient test that for the first time provides clinicians with a useful laboratory tool for point-of-care evaluation of patients with chest pain.

(JAMA. 1995;273:1279-1282)

Author Affiliations
From the Cardiovascular Division, Department of Medicine (Dr Antman), and the Clinical Chemistry Laboratory, Department of Pathology (Ms Grudzien and Dr Sacks), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Footnotes
Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 15, 1994.

Boehringer Mannheim, Indianapolis, Ind, supplied the rapid cTnT devices for the study along with the reagents and instrument for the quantitative cTnT assays. However, no financial support was provided by Boehringer Mannheim, and therefore this project was carried out independent of the manufacturers of the device with respect to scientific conception, patient acquisition, data analysis, and interpretation of the findings. Dr Sacks has received honoraria from Boehringer Mannheim for presentations he has given on the quantitative troponin T assay.

Reprint requests to Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Antman).

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