COMPARISON OF THE DIAGNOSTIC PERFORMANCE OF 2 RAPID BEDSIDE BIOCHEMICAL ASSAYS IN THE EARLY DETECTION OF ACUTE MYOCARDIAL-INFARCTION

Background: New biochemical markers have been recently proposed as pot ential aids in the diagnosis of myocardial infarction. Assessment of t hese markers in real time by near-patient testing would allow more rap id decisions regarding critical therapeutic interventions. Hypothesis: The diagnostic performance of two qualitative, whole blood assays for measurement of myoglobin/creatine kinase (CK)-MB mass (CARDIAC STATus (TM)) and cardiac troponin T (TropT(R)) was compared. Their potential in optimizing the rule-in of patients with infarction in order to init iate revascularization therapies was also evaluated. Methods: A group of 101 patients admitted to the hospital within 12 h from onset of sym ptoms suggestive of myocardial infarction was studied. A first blood s ample was drawn in all patients immediately after admission. In patien ts not receiving reperfusion therapy (n = 61), three additional sample s were also obtained 2, 4, and 6 h later. Results: CARDIAC STATus show ed good performance in patients with an admission time >2 h from onset of pain (diagnostic efficiency 71-100%). Conversely, TropT was not se nsitive enough for acceptable efficiency In a subset of 39 patients ad mitted within 6 h who did not meet standard enrollment criteria for th rombolysis, CARDIAC STATus allowed early detection of almost 50% of in farcts, enabling a significant implementation of alternative revascula rization therapies. Conclusions: in patients admitted to the coronary care unit on the basis of case history and clinical examination, CARDI AC STATus assay is more effective than TropT in the early diagnosis of infarction, providing a valuable aid to cardiologists for confirming a suspected infarction rapidly thus allowing, if indicated, recourse t o revascularization therapy in clinically uncertain cases.