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(Circulation. 2001;104:1483.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Ninety-Minute Exclusion of Acute Myocardial Infarction By Use of Quantitative Point-of-Care Testing of Myoglobin and Troponin I

James McCord, MD; Richard M. Nowak, MD, MBA; Peter A. McCullough, MD, MPH; Craig Foreback, PhD; Steven Borzak, MD; Glenn Tokarski, MD; Michael C. Tomlanovich, MD; Gordon Jacobsen, MS; W. Douglas Weaver, MD

Drs McCord and Nowak served on the Advisory Board of Biosite Diagnostics, the manufacturer of the Triage Cardiac Panel and a provider of funding for this study, in 2000. Dr McCullough served on the Advisory Board in 2000 and 2001.Correspondence to James McCord, MD, Henry Ford Hospital Center, 2799 W Grand Blvd, Detroit, MI 48202. E-mail jmccord1{at}hfhs.org

Background— Diagnostic strategies with ECG and serum cardiac markers have been used to rule out acute myocardial infarction in 6 to 12 hours. The present study evaluated whether a multimarker strategy that used point-of-care measurement of myoglobin, creatine kinase (CK)-MB, and troponin I could exclude acute myocardial infarction in 3 hours.

Methods and Results— We prospectively enrolled consecutive patients (n=817) in the emergency department who were evaluated for possible acute myocardial infarction. In patients with nondiagnostic ECGs, we measured CK-MB, troponin I, and myoglobin with a point-of-care device at presentation and at 90 minutes, 3 hours, and 9 hours. Standard central laboratory testing of CK-MB was done at the same time intervals, and triage decisions were made by emergency physicians who were unaware of point-of-care results. Sensitivity and negative predictive value were compared for both the multimarker, point-of-care approach and the central laboratory strategy. Sensitivity and negative predictive value for point-of-care combination of myoglobin and troponin I by 90 minutes was 96.9% and 99.6%, respectively. CK-MB measurements and blood sampling at 3 hours did not improve sensitivity or negative predictive value. Median time from sampling to reporting of results was 71.0 minutes for the central laboratory versus 24.0 minutes for the point-of-care device (P<0.001).

Conclusions— Acute myocardial infarction can be excluded rapidly in the emergency department by use of point-of-care measurements of myoglobin and troponin I during the first 90 minutes after presentation.

Key Words: myoglobin • creatine kinase • troponin • myocardial infarction

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