Clinical application of rapid quantitative determination of cardiac troponin-T in an emergency department setting

Objectives: We analysed the clinical use of Troponin-T compared to creatine kinase MB in a non-trauma emergency department setting. Background: A newl y established single specimen quantitative Troponin T assay allows the clin ical application of this parameter. Methods. Five-hundred Troponin T tests were provided for use by emergency physicians who could combine them with t he routine laboratory tests without restriction as to the indication or num ber of tests per patient. The number of tests per patient, time frame, fina l diagnosis and additional clinical information gained were recorded. All p atients were followed for at least 6 months to verify the diagnosis and to assess the occurrence of cardiac events (nonfatal AMI or cardiac death). Th e ability of Troponin T and creatine kinase MB tests to predict cardiac eve nts within 6 months were compared. Results: The 500 Troponin T tests were u sed in 249 patients (median two tests per patient (range 1-5)) within 41 da ys. The final diagnosis revealed coronary heart disease in 85, non-coronary heart disease in 39, non-cardiac chest pain in 86 and other diagnoses in 3 9 of the patients. In 14 patients with an elevated creatine kinase MB, myoc ardial damage could safely be ruled out by a negative Troponin T, in six pa tients with a normal creatine kinase MB minor myocardial damage could be de tected by a positive Troponin T. During follow up 28 cardiac events were re corded. Troponin T had a significantly higher specificity, positive predict ive value and proportion of correct prediction for cardiac events within 6 months compared to creatine kinase MB. Conclusions: Troponin T has proved t o be an useful method for diagnosing myocardial damage in routine clinical use in the non-trauma emergency department. (C) 2001 Elsevier Science Irela nd Ltd. All rights reserved.