Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department

M. Stephen Baxter, Gerard X. Brogan, Fred P. Harchelroad, Kevin J. Knoop, Scott W. Zackowski, Richard J. Ryan, J. Lee Garvey, Robert D. Greenberg, James H. Huey, M. Scott Línscott, I. Wen Chen, Matthew Sperling, Victoria L. Castelli, Tiepu Liu, W. Brian Gibler, Robert (Bob) Lowe

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: To evaluate the performance of a new bedside whole-blood rapid assay for cardiac troponin T (cTnT) in patients presenting to the ED with symptoms consistent with acute coronary ischemia. Methods: A prospective, observational trial was performed in 8 participating medical centers. Serial blood samples were obtained on presentation to the ED and 3 and 6 hours later. The cTnT whole-blood rapid assays were performed immediately at the site. Treating physicians and patients were blinded to the results of the rapid assays. Serum samples were analyzed at the core laboratory for serum cTnT, creatine kinase (CK)-MB, and myoglobin. The sensitivity of the rapid assay for detecting acute myocardial infarction (AMI) was compared with the sensitivities of serum cTnT, CK-MB, and myoglobin assays. Results: Of 721 patients, 102 were diagnosed as having AMI. The median elapsed time from symptom onset to ED arrival was 3 hours. The sensitivities of the rapid assay for detecting AMI were 19.6%, 59.0%, and 69.7% at 0, 3, and 6 hours, respectively. The sensitivities of the serum cTnT assay (p-values for comparison with the rapid assay for cTnT) were 25.0% (p = 0.18), 69.6% (p = 0.04), and 79.8% (p = 0.02) at 0, 3, and 6 hours, respectively. The CK-MB and myoglobin sensitivities were 21.9%, 64.5%, and 81.0%; and 43.8%, 77.4%, and 71.4%, respectively. There were 7 patients with AMI who had negative rapid assay readings and positive serum cTnT levels; 4 of these patients were enrolled at the same site. Twenty patients not diagnosed as having AMI had at least one positive rapid assay. Fourteen of these 20 patients had a diagnosis of clinically relevant cardiac disease. Conclusions: The sensitivity of this whole-blood rapid cTnT assay for detecting AMI is comparable to that of current serum assays and offers the advantage of providing rapid bedside results. Discrepancies between serum and whole-blood assays for cTnT noted in this study may indicate the need for further education for the test reader prior to patient use.

Original languageEnglish (US)
Pages (from-to)1018-1024
Number of pages7
JournalAcademic Emergency Medicine
Volume4
Issue number11
StatePublished - 1997
Externally publishedYes

Fingerprint

Troponin T
Hospital Emergency Service
Myocardial Infarction
MB Form Creatine Kinase
Serum
Myoglobin
Reading
Heart Diseases
Ischemia
Physicians
Education

Keywords

  • Bedside testing
  • CK-MB
  • Diagnostic testing
  • Emergency department
  • Myocardial ischemia
  • Myoglobin
  • Troponin T

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Baxter, M. S., Brogan, G. X., Harchelroad, F. P., Knoop, K. J., Zackowski, S. W., Ryan, R. J., ... Lowe, R. B. (1997). Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department. Academic Emergency Medicine, 4(11), 1018-1024.

Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department. / Baxter, M. Stephen; Brogan, Gerard X.; Harchelroad, Fred P.; Knoop, Kevin J.; Zackowski, Scott W.; Ryan, Richard J.; Garvey, J. Lee; Greenberg, Robert D.; Huey, James H.; Línscott, M. Scott; Chen, I. Wen; Sperling, Matthew; Castelli, Victoria L.; Liu, Tiepu; Gibler, W. Brian; Lowe, Robert (Bob).

In: Academic Emergency Medicine, Vol. 4, No. 11, 1997, p. 1018-1024.

Research output: Contribution to journalArticle

Baxter, MS, Brogan, GX, Harchelroad, FP, Knoop, KJ, Zackowski, SW, Ryan, RJ, Garvey, JL, Greenberg, RD, Huey, JH, Línscott, MS, Chen, IW, Sperling, M, Castelli, VL, Liu, T, Gibler, WB & Lowe, RB 1997, 'Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department', Academic Emergency Medicine, vol. 4, no. 11, pp. 1018-1024.
Baxter MS, Brogan GX, Harchelroad FP, Knoop KJ, Zackowski SW, Ryan RJ et al. Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department. Academic Emergency Medicine. 1997;4(11):1018-1024.
Baxter, M. Stephen ; Brogan, Gerard X. ; Harchelroad, Fred P. ; Knoop, Kevin J. ; Zackowski, Scott W. ; Ryan, Richard J. ; Garvey, J. Lee ; Greenberg, Robert D. ; Huey, James H. ; Línscott, M. Scott ; Chen, I. Wen ; Sperling, Matthew ; Castelli, Victoria L. ; Liu, Tiepu ; Gibler, W. Brian ; Lowe, Robert (Bob). / Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department. In: Academic Emergency Medicine. 1997 ; Vol. 4, No. 11. pp. 1018-1024.
@article{0469f9a2c84d4276b12fc1288bbe0932,
title = "Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department",
abstract = "Objective: To evaluate the performance of a new bedside whole-blood rapid assay for cardiac troponin T (cTnT) in patients presenting to the ED with symptoms consistent with acute coronary ischemia. Methods: A prospective, observational trial was performed in 8 participating medical centers. Serial blood samples were obtained on presentation to the ED and 3 and 6 hours later. The cTnT whole-blood rapid assays were performed immediately at the site. Treating physicians and patients were blinded to the results of the rapid assays. Serum samples were analyzed at the core laboratory for serum cTnT, creatine kinase (CK)-MB, and myoglobin. The sensitivity of the rapid assay for detecting acute myocardial infarction (AMI) was compared with the sensitivities of serum cTnT, CK-MB, and myoglobin assays. Results: Of 721 patients, 102 were diagnosed as having AMI. The median elapsed time from symptom onset to ED arrival was 3 hours. The sensitivities of the rapid assay for detecting AMI were 19.6{\%}, 59.0{\%}, and 69.7{\%} at 0, 3, and 6 hours, respectively. The sensitivities of the serum cTnT assay (p-values for comparison with the rapid assay for cTnT) were 25.0{\%} (p = 0.18), 69.6{\%} (p = 0.04), and 79.8{\%} (p = 0.02) at 0, 3, and 6 hours, respectively. The CK-MB and myoglobin sensitivities were 21.9{\%}, 64.5{\%}, and 81.0{\%}; and 43.8{\%}, 77.4{\%}, and 71.4{\%}, respectively. There were 7 patients with AMI who had negative rapid assay readings and positive serum cTnT levels; 4 of these patients were enrolled at the same site. Twenty patients not diagnosed as having AMI had at least one positive rapid assay. Fourteen of these 20 patients had a diagnosis of clinically relevant cardiac disease. Conclusions: The sensitivity of this whole-blood rapid cTnT assay for detecting AMI is comparable to that of current serum assays and offers the advantage of providing rapid bedside results. Discrepancies between serum and whole-blood assays for cTnT noted in this study may indicate the need for further education for the test reader prior to patient use.",
keywords = "Bedside testing, CK-MB, Diagnostic testing, Emergency department, Myocardial ischemia, Myoglobin, Troponin T",
author = "Baxter, {M. Stephen} and Brogan, {Gerard X.} and Harchelroad, {Fred P.} and Knoop, {Kevin J.} and Zackowski, {Scott W.} and Ryan, {Richard J.} and Garvey, {J. Lee} and Greenberg, {Robert D.} and Huey, {James H.} and L{\'i}nscott, {M. Scott} and Chen, {I. Wen} and Matthew Sperling and Castelli, {Victoria L.} and Tiepu Liu and Gibler, {W. Brian} and Lowe, {Robert (Bob)}",
year = "1997",
language = "English (US)",
volume = "4",
pages = "1018--1024",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Evaluation of a bedside whole-blood rapid troponin T assay in the emergency department

AU - Baxter, M. Stephen

AU - Brogan, Gerard X.

AU - Harchelroad, Fred P.

AU - Knoop, Kevin J.

AU - Zackowski, Scott W.

AU - Ryan, Richard J.

AU - Garvey, J. Lee

AU - Greenberg, Robert D.

AU - Huey, James H.

AU - Línscott, M. Scott

AU - Chen, I. Wen

AU - Sperling, Matthew

AU - Castelli, Victoria L.

AU - Liu, Tiepu

AU - Gibler, W. Brian

AU - Lowe, Robert (Bob)

PY - 1997

Y1 - 1997

N2 - Objective: To evaluate the performance of a new bedside whole-blood rapid assay for cardiac troponin T (cTnT) in patients presenting to the ED with symptoms consistent with acute coronary ischemia. Methods: A prospective, observational trial was performed in 8 participating medical centers. Serial blood samples were obtained on presentation to the ED and 3 and 6 hours later. The cTnT whole-blood rapid assays were performed immediately at the site. Treating physicians and patients were blinded to the results of the rapid assays. Serum samples were analyzed at the core laboratory for serum cTnT, creatine kinase (CK)-MB, and myoglobin. The sensitivity of the rapid assay for detecting acute myocardial infarction (AMI) was compared with the sensitivities of serum cTnT, CK-MB, and myoglobin assays. Results: Of 721 patients, 102 were diagnosed as having AMI. The median elapsed time from symptom onset to ED arrival was 3 hours. The sensitivities of the rapid assay for detecting AMI were 19.6%, 59.0%, and 69.7% at 0, 3, and 6 hours, respectively. The sensitivities of the serum cTnT assay (p-values for comparison with the rapid assay for cTnT) were 25.0% (p = 0.18), 69.6% (p = 0.04), and 79.8% (p = 0.02) at 0, 3, and 6 hours, respectively. The CK-MB and myoglobin sensitivities were 21.9%, 64.5%, and 81.0%; and 43.8%, 77.4%, and 71.4%, respectively. There were 7 patients with AMI who had negative rapid assay readings and positive serum cTnT levels; 4 of these patients were enrolled at the same site. Twenty patients not diagnosed as having AMI had at least one positive rapid assay. Fourteen of these 20 patients had a diagnosis of clinically relevant cardiac disease. Conclusions: The sensitivity of this whole-blood rapid cTnT assay for detecting AMI is comparable to that of current serum assays and offers the advantage of providing rapid bedside results. Discrepancies between serum and whole-blood assays for cTnT noted in this study may indicate the need for further education for the test reader prior to patient use.

AB - Objective: To evaluate the performance of a new bedside whole-blood rapid assay for cardiac troponin T (cTnT) in patients presenting to the ED with symptoms consistent with acute coronary ischemia. Methods: A prospective, observational trial was performed in 8 participating medical centers. Serial blood samples were obtained on presentation to the ED and 3 and 6 hours later. The cTnT whole-blood rapid assays were performed immediately at the site. Treating physicians and patients were blinded to the results of the rapid assays. Serum samples were analyzed at the core laboratory for serum cTnT, creatine kinase (CK)-MB, and myoglobin. The sensitivity of the rapid assay for detecting acute myocardial infarction (AMI) was compared with the sensitivities of serum cTnT, CK-MB, and myoglobin assays. Results: Of 721 patients, 102 were diagnosed as having AMI. The median elapsed time from symptom onset to ED arrival was 3 hours. The sensitivities of the rapid assay for detecting AMI were 19.6%, 59.0%, and 69.7% at 0, 3, and 6 hours, respectively. The sensitivities of the serum cTnT assay (p-values for comparison with the rapid assay for cTnT) were 25.0% (p = 0.18), 69.6% (p = 0.04), and 79.8% (p = 0.02) at 0, 3, and 6 hours, respectively. The CK-MB and myoglobin sensitivities were 21.9%, 64.5%, and 81.0%; and 43.8%, 77.4%, and 71.4%, respectively. There were 7 patients with AMI who had negative rapid assay readings and positive serum cTnT levels; 4 of these patients were enrolled at the same site. Twenty patients not diagnosed as having AMI had at least one positive rapid assay. Fourteen of these 20 patients had a diagnosis of clinically relevant cardiac disease. Conclusions: The sensitivity of this whole-blood rapid cTnT assay for detecting AMI is comparable to that of current serum assays and offers the advantage of providing rapid bedside results. Discrepancies between serum and whole-blood assays for cTnT noted in this study may indicate the need for further education for the test reader prior to patient use.

KW - Bedside testing

KW - CK-MB

KW - Diagnostic testing

KW - Emergency department

KW - Myocardial ischemia

KW - Myoglobin

KW - Troponin T

UR - http://www.scopus.com/inward/record.url?scp=9844260080&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=9844260080&partnerID=8YFLogxK

M3 - Article

C2 - 9383485

AN - SCOPUS:9844260080

VL - 4

SP - 1018

EP - 1024

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 11

ER -