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1
Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, MN 55415.
2
Departments of Pathology and Medical Research
Technology, University of Maryland School of Medicine, Baltimore, MD
21201.
3
Department of Pathology and Laboratory Medicine,
University of Louisville, School of Medicine, Louisville, KY 40292.
4
Department of Pathology, Hartford Hospital, Hartford, CT
06102.
a Address correspondence to this author at: Hennepin County Medical Center, Clinical Laboratories No. 812, 701 Park Ave., Minneapolis, MN 55415. Fax 612-904-4229; e-mail fred.apple{at}co.hennepin.mn.us.
This multicenter study evaluated the Biosite Triage® Cardiac Panel as a quantitative, multimarker, whole blood system for the detection of acute myocardial infarction (MI). Optimum cutoffs for the discrimination of acute MI (n = 192 patients, 59 with MI) as determined by ROC curve analyses were as follows: 0.4 µg/L for cardiac troponin I (cTnI); 4.3 µg/L for the creatine kinase MB isoenzyme (CK-MB); and 107 µg/L for myoglobin. The Triage Panel showed the following concordances for detection or rule-out of MI compared with established devices: cTnI >89%; CK-MB >81%; myoglobin >69%. No significant differences were present between methods for the same marker. Diagnostic efficiencies demonstrated comparable sensitivities and specificities for the diagnosis of MI in patients presenting with symptoms compared with the Dade, Beckman, and Behring CK-MB, cTnI, and myoglobin assays; the ratio of sensitivity to specificity for each marker was as follows: cTnI, 98%:100%; CK-MB, 95%:91%; myoglobin, 81%:92%. The areas under the ROC curves for the Biosite myoglobin, CK-MB, and cTnI were 0.818, 0.905, and 0.970, respectively; the areas were significantly different, P <0.05. In patients with skeletal muscle injury and renal disease, the Triage cTnI showed 94% and 100% specificity, respectively. The Triage panel offers clinicians a whole blood, point-of-care analysis of multiple cardiac markers that provides excellent clinical sensitivity and specificity for the detection of acute MI.
The following articles in journals at HighWire Press have cited this article:
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  C. W. Hamm, H. Möllmann, J.-P. Bassand, and F. van de Werf CHAPTER 16 Acute Coronary Syndromes ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
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 H. C. Chew Cardiac Troponin T in Acute Coronary Syndrome with Renal Insufficiency Asian Cardiovasc Thorac Ann, August 1, 2008; 16(4): 284 - 287. [Abstract] [Full Text] [PDF]
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 J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]
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D. Abramov, M. Abu-Tailakh, M. Frieger, A. Ganiel, D. Tuvbin, and A. Wolak Plasma Troponin Levels After Cardiac Surgery vs After Myocardial Infarction Asian Cardiovasc Thorac Ann, December 1, 2006; 14(6): 530 - 535. [Abstract] [Full Text] [PDF]
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 R. Bassan, A. Potsch, A. Maisel, B. Tura, H. Villacorta, M. V. Nogueira, A. Campos, R. Gamarski, A. C. Masetto, and M. A. Moutinho B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation Eur. Heart J., February 1, 2005; 26(3): 234 - 240. [Abstract] [Full Text] [PDF]
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 P. von Lode, J. Rainaho, and K. Pettersson Quantitative, Wide-Range, 5-Minute Point-of-Care Immunoassay for Total Human Chorionic Gonadotropin in Whole Blood Clin. Chem., June 1, 2004; 50(6): 1026 - 1035. [Abstract] [Full Text] [PDF]
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 J. McCord, R. M. Nowak, P. A. McCullough, C. Foreback, S. Borzak, G. Tokarski, M. C. Tomlanovich, G. Jacobsen, and W. D. Weaver Ninety-Minute Exclusion of Acute Myocardial Infarction By Use of Quantitative Point-of-Care Testing of Myoglobin and Troponin I Circulation, September 25, 2001; 104(13): 1483 - 1488. [Abstract] [Full Text] [PDF]
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Y. Fischer, K. Filzmaier, H. Stiegler, J. Graf, S. Fuhs, A. Franke, U. Janssens, and A. M. Gressner Evaluation of a New, Rapid Bedside Test for Quantitative Determination of B-Type Natriuretic Peptide Clin. Chem., March 1, 2001; 47(3): 591 - 594. [Full Text] [PDF]
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F. S. Apple, F. P. Anderson, P. Collinson, R. L. Jesse, M. C. Kontos, M. A. Levitt, E. A. Miller, and M. M. Murakami Clinical Evaluation of the First Medical Whole Blood, Point-of-Care Testing Device for Detection of Myocardial Infarction Clin. Chem., October 1, 2000; 46(10): 1604 - 1609. [Abstract] [Full Text] [PDF]
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E. Braunwald, E. M. Antman, J. W. Beasley, R. M. Califf, M. D. Cheitlin, J. S. Hochman, R. H. Jones, D. Kereiakes, J. Kupersmith, T. N. Levin, et al. ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction: A report of the american college of cardiology/ american heart association task force on practice guidelines (committee on the management of patients with unstable angina) J. Am. Coll. Cardiol., September 1, 2000; 36(3): 970 - 1062. [Full Text] [PDF]
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C. Heeschen, B. U. Goldmann, L. Langenbrink, G. Matschuck, and C. W. Hamm Evaluation of a Rapid Whole Blood ELISA for Quantification of Troponin I in Patients with Acute Chest Pain Clin. Chem., October 1, 1999; 45(10): 1789 - 1796. [Abstract] [Full Text] [PDF]
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A. H.B. Wu, F. S. Apple, W. B. Gibler, R. L. Jesse, M. M. Warshaw, and R. Valdes Jr. National Academy of Clinical Biochemistry Standards of Laboratory Practice: Recommendations for the Use of Cardiac Markers in Coronary Artery Diseases Clin. Chem., July 1, 1999; 45(7): 1104 - 1121. [Abstract] [Full Text] [PDF]
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