The Sensitivity of Cardiac Markers: an Evidence-based Approach
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Mauro Panteghini
Abstract
The aim of this study was to determine whether, using an evidence-based approach, the results of the papers found in the literature are valid and sufficiently scientifically rigorous to be used to definitely address the problem of cardiac marker sensitivity in detection of acute myocardial infarction. In particular, the diagnostic sensitivities of myoglobin, creatine kinase (CK)-MB isoenzyme, determined as mass concentration, CK-MB isoforms, and of the two cardiac troponins, troponin I and troponin T, were reviewed using a priori formulated inclusion/exclusion criteria for judging the eligibility of studies to be included in the analysis. A clear final message derived from this systematic analysis is the unacceptably poor diagnostic sensitivity of all evaluated markers at patient admission, with substantial failure rate to rule out myocardial infarction at this time. Myoglobin is at present the most sensitive of the markers studied for excluding early AMI with an optimum timing of sampling at patient presentation and approximately 4 h later. However, this marker cannot be used by itself as a proportion of patients admitted to the hospital with a late infarction could be missed. The early rate of rise of CK-MB mass and troponin T is similar. Maximum sensitivity of these two parameters is achieved by the analysis of a second sample 6 to 12 h after admission. Additional larger studies are needed to address the question which troponin shows earlier release after myocardial damage, and to clarify the role of CK-MB isoforms as a possible early marker of myocardial infarction.
Copyright © 1999 by Walter de Gruyter GmbH & Co. KG
Articles in the same Issue
- Author Index
- Contents
- Subject Index
- Strategies for Cardiac Marker Measurement
- Statistical Techniques for Evaluating the Diagnostic Utility of Laboratory Tests
- Magnesium in Disease: a Review with Special Emphasis on the Serum Ionized Magnesium
- Methods for Improving Clinical Trials
- Infrared Analysis of Urinary Stones: a Trial of Automated Identification
- Evaluation of a Direct α-Amylase Assay Using 2-Chloro-4-nitrophenyl-α-D-maltotrioside
- Accurate Platelet Counting in an Insidious Case of Pseudothrombocytopenia
- A New Liquid Homogeneous Assay for HDL Cholesterol Determination Evaluated in Seven Laboratories in Europe and the United States
- Tissue Release of Cardiac Markers: from Physiology to Clinical Applications
- The Specificity of Biochemical Markers of Cardiac Damage: a Problem Solved
- Biochemical Factors Influencing Measurement of Cardiac Troponin I in Serum
- The Sensitivity of Cardiac Markers: an Evidence-based Approach
- Risk Stratification and Therapeutic Decision Making in Patients with Acute Coronary Syndromes the Role of Cardiac Troponin T
- Cardiac Markers: Centralized or Decentralized Testing?
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Articles in the same Issue
- Author Index
- Contents
- Subject Index
- Strategies for Cardiac Marker Measurement
- Statistical Techniques for Evaluating the Diagnostic Utility of Laboratory Tests
- Magnesium in Disease: a Review with Special Emphasis on the Serum Ionized Magnesium
- Methods for Improving Clinical Trials
- Infrared Analysis of Urinary Stones: a Trial of Automated Identification
- Evaluation of a Direct α-Amylase Assay Using 2-Chloro-4-nitrophenyl-α-D-maltotrioside
- Accurate Platelet Counting in an Insidious Case of Pseudothrombocytopenia
- A New Liquid Homogeneous Assay for HDL Cholesterol Determination Evaluated in Seven Laboratories in Europe and the United States
- Tissue Release of Cardiac Markers: from Physiology to Clinical Applications
- The Specificity of Biochemical Markers of Cardiac Damage: a Problem Solved
- Biochemical Factors Influencing Measurement of Cardiac Troponin I in Serum
- The Sensitivity of Cardiac Markers: an Evidence-based Approach
- Risk Stratification and Therapeutic Decision Making in Patients with Acute Coronary Syndromes the Role of Cardiac Troponin T
- Cardiac Markers: Centralized or Decentralized Testing?
- EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry. Version 2 – 1999
- Plasma Malondialdehyde and Obesity: Is there a Relationship?
- Reference Intervals: Are Interlaboratory Differences Appropriate?
- Lipoprotein Protocols. By J.M. Ordovas, editor
- Tietz Textbook of Clinical Chemistry. By C.A. Burtis and E.R. Ashwood, editors
