Rapid Troponin Research Articles

Characteristics of deceased subjects transported to a postmortem imaging center due to unusual death related to epilepsy.

Patients with epilepsy have high risk of experiencing uncommon causes of death. This study aimed to evaluate patients who underwent unusual deaths related to epilepsy and identify factors that may contribute to these deaths and may also include sudden unexpected death in epilepsy (SUDEP). We analyzed 5291 cases in which a postmortem imaging (PMI) study was performed using plane CT, because of an unexplained death. A rapid troponin T assay was performed using peripheral blood samples. Clinical information including the cause of death suspected by the attending physician, body position, place of death, medical history, and antiseizure medications was evaluated. A total of 132 (2.6%) patients had an obvious history of epilepsy, while 5159 individuals had no history of epilepsy (97.4%). Cerebrovascular disease was the cause of death in 1.6% of patients in the group with epilepsy, and this was significantly lower than that in the non-epilepsy group. However, drowning was significantly higher (9.1% vs. 4.4%). Unspecified cause of death was significantly more frequent in the epilepsy group (78.0% vs. 57.8%). Furthermore, the proportion of patients who demonstrated elevation of troponin T levels without prior cardiac disease was significantly higher in the epilepsy group (37.9% vs. 31.1%). At discovery of death, prone position was dominant (30.3%), with deaths occurring most commonly in the bedroom (49.2%). No antiseizure medication had been prescribed in 12% of cases, while 29.5% of patients were taking multiple antiseizure medications. The prevalence of epilepsy in individuals experiencing unusual death was higher than in the general population. Despite PMI studies, no definitive cause of death was identified in a significant proportion of cases. The high troponin T levels may be explained by long intervals between death and examination or by higher incidence of myocardial damage at the time of death. This study investigated unusual deaths in epilepsy patients, analyzing 5291 postmortem imaging cases. The results showed that 132 cases (2.6%) had a clear history of epilepsy. In these cases, only 22% cases were explained after postmortem examination, which is less than in non-epilepsy group (42.2%). Cerebrovascular disease was less common in the epilepsy group, while drowning was more common. Elevated troponin T levels, which suggest possibility of myocardial damage or long intervals between death and examination, were also more frequent in the epilepsy group compared to non-epilepsy group.

Real-life evaluation of hypersensitive I-troponin on a point-of care analyser in an emergency unit

European Society of Cardiology (ESC) guidelines allow to perform rapid rule-in and rule-out algorithm with rapid troponin kinetics for the management of suspected Non ST-elevation acute coronary syndrome. These recommendations allow the use of point-of-care testing (POCT) systems provided that they have sufficient analytical performance. The aim of our study was to evaluate in real life the feasibility and performance of using a high sensitivity cardiac troponin I POCT system assay (hs-cTnI, Atellica® VTLi, Siemens) compared to high sensitivity cardiac troponin T values (hs-cTnT, e602®, Roche) obtained for patients admitted to emergency department. Analytical verification showed a coefficient of variation below 10% for hs-cTnI. Comparison of both troponins was moderate (r=0.7). The study included 117 patients with a median age of 65 years, 30% had renal failure and 36% presented with chest pain. In this study, the hs-cTnT value was, more often, higher than the 99th percentile than the hs-cTnl value, even for an age-adjusted 99th percentile hs-cTnT value. The concordance of the results was moderate (Cohen's Kappa: 0.54), age remaining the most important explanatory value of discordance. Only hs-cTnT had a predictive value for hospitalization. We did not observe any interpretation discrepancies for patients who had troponin kinetics. This study confirms the feasibility of using a POCT analyzer in the emergency department, provided that it performs high sensitivity troponin. However, some data are missing to be able to use it in the framework of rapid algorithm. Finally, the implementation of POCT requires collaboration between biologists and emergency physicians in terms of organization and interpretation of values, for the overall benefit of the patient.

Is it time to use rapid troponin test in triage room?

With great interest, we read the notable publication in the recent Eur Heart J Acute Cardiovasc Care from Miró et al, entitled ‘External validation of an emergency department triage algorithm for chest pain patients’.1 In their study, the researchers developed a five-item triage algorithm composed of five clinical high-risk variables to identify patients with low-risk chest pain, presented in three models of A, B, and C. Data were collected from multicenter databases (The CLINIC BARCELONA and APACE cohorts). Low efficacy ranging from 2.7% to 6.2% was achieved in case of keeping sensitivity <99% in Model A.1 Allowing the presence of one clinical high-risk variable resulted in an efficacy of 23.1% instead of a sensitivity fall to 96.7%, raises a substantial limitation in the algorithm. In all three models both groups achieve high sensitivity with very low efficiency. It suggests that trust on medical history (high-risk clinical factors) to identify patients with chest pain is associated with poor efficacy over and over again. The results also cast doubt on the appliance of the algorithm, especially in patients above 40 with an odd ratio of 6.60, suggesting that the results may be influenced by the age, while other items showed lower odd ratio, less than 3 (2.56, 1.86, 1.83, 1.23). As chest pain may not be a significant risk factor in patients aged below 40, history alone may be neither effective nor efficient in diagnostic process of patients with chest pain. To increase efficiency, adding electrocardiogram (ECG) to the history has been suggested to significantly increase in effectiveness for identifying patients with low-risk chest pain, Patients with HEAR scores < 3 represent a low-risk group with a sensitivity of 92.5%, an efficacy of 38%, and a MACE rate less than 1% are reported.2 Although the sensitivity of 92.5% still raises concerns, and using electrocardiogram is a relatively time-consuming compared to rapid hscTn testing, it is still routine for diagnosing high-risk patients with acceptable effectiveness. Now, the question is whether hs-cTn could be considered as an alternative to ECG in the triage room.

Long-term outcomes in patients with acute myocardial infarction and no ischemic changes on electrocardiogram

BackgroundAcute myocardial infarction (MI) is commonly associated with ischemic abnormalities on electrocardiography (ECG). However, a significant proportion of patients present with no ischemic changes (NIC), and their baseline characteristics and management differ considerably from those with other ECG patterns. In the era of rapid troponin assays, the exact prognostic effects of normal ECGs remain unclear. ObjectivesThis study aimed to compare the outcomes of patients with MI without ischemic changes and those with other ECG patterns. MethodsBetween 2012 and 2018, 155,073 patients with MI were enrolled in the prospective nationwide Polish Registry of Acute Coronary Syndromes (PL-ACS). The patients were assigned to one of the following groups: NIC, ST-segment elevation (STE), ST-segment depression (STD), T-wave inversion (TWI), and other ST-T abnormalities (STT). ResultsThe NIC group accounted for 9.56% of all patients. The in-hospital risk of death was lower in the TWI group than in the NIC group. In the STE, STD, and STT groups, the short-term results were substantially worse. During the 12-month observation period, TWI had the best prognosis. The worst long-term prognoses were associated with STT and STD. The outcomes of the STE and NIC groups were similar (12-month death rate 9.0% vs. 8.7%, respectively; P=0.534), despite the fact STE was an independent predictor of 12-month prognosis. ConclusionsThe prognosis of patients with MI and NIC is not as favorable as previously thought. Their long-term outcomes were equal to those of the TWI and STE MI groups.

Scoping review of Cardiac Troponin Test in the Prehospital Management of Non-ST-Elevation Myocardial Infarction in Qatar

Background: Acute coronary syndrome (ACS) is one of the most common life-threatening diseases worldwide.1 Early diagnosis, advanced cardiac life support, and rapid transportation to a cardiac center are essential to reduce mortality and morbidity. ST-segment elevation myocardial infarctions (STEMI) are life-threatening and are diagnosed with a 12-lead electrocardiogram (ECG). However, non-STEMI (NSTEMI) is not prioritized as a STEMI in the prehospital setting. Studies have confirmed that patients who are diagnosed with an ACS in the prehospital setting are more likely to survive.2,3Method: A scoping review was conducted based on the above topic. Limited data is available on prehospital cardiac troponin tests for NSTEMI. Discussion: Paramedics from the national Ambulance Service in Qatar diagnose patients with ACS based on the findings of a 12-lead ECG, clinical presentation, abnormalities in vital signs, physical examination, and congruent history which is compatible with the American Heart Association and European Resuscitation Council recommendations. In a case of NSTEMI chest pain, the paramedic cannot rule out Acute Myocardial Infarction (AMI), yet the patient will be taken to the normal emergency department until further investigations are done.1 ACS remains a challenge to diagnose in the prehospital setting as the diverse population in Qatar makes communication often difficult which would negatively impact the patient&apos;s assessment. Although the accuracy of prehospital Troponin tests done around 2010 was relatively encouraging2, their sensitivity has now significantly improved and warrants further studies to highlight their benefit to patient care.3 The routing of patients with ACS (STEMI and NSTEMI) to the appropriate cardiac center is essential to assure they receive a rapid diagnosis and appropriate care. Conclusion: The enhanced diagnostic accuracy of ACS in the prehospital setting by using a rapid Troponin test is expected to accelerate the care of NSTEMI patients and should be explored in Qatar. This scoping review indicates that limited data is available on cardiac troponin tests for NSTEMI.

A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: Design of the Rapid Assessment of Possible ACS In the emergency Department with high sensitivity Troponin T (RAPID-TnT) study

Protocols incorporating high-sensitivity troponin to guide decision making in the disposition of patients with suspected acute coronary syndromes (ACS) in the emergency department have received a lot of attention. Traditionally, patients with chest pain have required long periods of observation in emergency department before being deemed safe for discharge. In an era of limited health service resources, a protocol that could discharge patients safely within an hour of presentation is extremely attractive. Unfortunately, despite incorporation into some guidelines, these protocols have not been subjected to randomized comparisons evaluating safety, effectiveness, and cost-effectiveness. This study is designed to provide the evidence required to allow key decision makers to implement these protocols: specifically, to provide evidence that a decision rule based on 0- and 1-hour high-sensitivity troponin T (hs-TnT) is safe, provides noninferior outcomes in all patients with suspected ACS, and that implementation of a rapid troponin protocol leads to efficient care. This prospective pragmatic trial (n=5,400, 5 hospitals) randomly allocates patients with suspected ACS to either a 0/1-hour hs-TnT protocol as advocated in clinical guidelines, versus usual care of standard troponin reporting evaluated at 3 and 6hours. The primary effectiveness composite end points of this study are all-cause death and new/recurrent ACS within 30days. To evaluate cost-effectiveness, follow-up will determine clinical events, quality of life, and resource utilization within 12 months. Demonstrating that a 0/1-hour hs-TnT protocol improves the effectiveness and efficiency of care within a robust comparative study will fill an evidence gap that currently limits the translation of more precise hs-TnT testing into better patient and health service outcomes.

Operating characteristics of a qualitative troponin assay for the diagnosis of acute coronary syndrome

The troponin I serum level is widely used in acute coronary syndrome patients for their classification. The qualitative assay is faster and more available than the quantitative assay. The objective was to determine the operating characteristics of a qualitative troponin I assay compared with a quantitative method. This is a prospective observational study and patients suspected to have acute coronary syndrome were enrolled. A rapid troponin I test and a quantitative assay were carried out for each patient on arrival and 6 h after admission. A total of 262 patients were enrolled. The degree of agreement between the second rapid qualitative and quantitative troponin I was excellent (κ=0.946; 95% confidence interval, 0.903-0.989). The sensitivity, specificity, negative predictive value, and positive predictive value of the rapid qualitative troponin I test were 92.6, 100, 96.8, and 100%, respectively. In conclusion, this study reveals an excellent agreement between quantitative and qualitative bedside assays 6 h after admission in a sample of Iranian patients in the emergency department.

Renal cell carcinoma presenting as a stress cardiomyopathy

A 76-year-old woman was admitted to the emergency department with a squeezing severe chest pain starting at rest, 1h before. Previous medical history was unremarkable. An electrocardiogram showed rapidly evolving ST-segment changes ( Panels A–C ). The rapid troponin I assay was positive (1.4 ng/mL). Unknown renal dysfunction was also noted (creatinine of 1.7 mg/dL). Apical akinesia was present on bedside echocardiogram (TEE). Urgent coronary angiography due to unremitting chest pain and hypotension excluded obstructive coronary disease. Ventriculography showed a striking pattern of apical akinesia ( Panels D and E …

107: Evaluation of a new, high sensitive, rapid troponin I assay (pathfast) in acute coronary syndrome patients of the atherogene-study

107: Evaluation of a new, high sensitive, rapid troponin I assay (pathfast) in acute coronary syndrome patients of the atherogene-study

Evaluation of RAMP Troponin I Point of Care Assay

Rapid troponin testing has become a prerequisite for adequate and timely management of chest pain patients. In that respect, quantitative point of care testing (POCT) devices, if reliable, would offer the benefit of greatly reduced turnaround time (TAT) as compared with centralized testing. Thus, we performed short analytical evaluation of the TnI method on RAMP POCT device (Rapid Analysis Measurement Platform, RAMP Corp, Burnaby, Canada). It is a fluorescence immunochromatography quantitative method that utilizes diluted whole blood. Results are available after 19 minutes. The analytical sensitivity of the system is shown to be 0.16 ng/ml, which makes it inadequate for risk stratification purposes. Reproducibility at 1.18 ng/ml was 7.3%, which is satisfactory and comparable to laboratory methods. The patients' results were compared with Dimension RxL (Dade Behring, Deerfield, IL) fully automated EIA method (N = 50). The correlation coefficient for the whole patient series was acceptable (0.977); however, it became much less favorable (0.682) when values above 6 ng/ml were excluded. Linear regression equation (y = 0.2871x + 0.0986) pointed out the consistently lower values obtained by RAMP method. The bias was on the average three-fold and thus statistically significant. This raises particular concern for the patients in the early stages of AMI with minor troponin elevations. Although obtained on a small patient series, our results point out that RAMP AMI cut-off should be chosen carefully to avoid false negatives. The 0.3 ng/ml cut-off suggested by the manufacturer may still be too high.

Use of a whole blood rapid panel test for heart-type fatty acid–binding protein in patients with acute chest pain: comparison with rapid troponin T and myoglobin tests

Use of a whole blood rapid panel test for heart-type fatty acid–binding protein in patients with acute chest pain: comparison with rapid troponin T and myoglobin tests

Use of a Whole Blood Rapid Panel Test for heart-type fatty acid–binding protein in patients with acute chest pain: comparison with Rapid Troponin T and Myoglobin Tests

Purpose We sought to determine the clinical utility of a newly developed qualitative test to measure heart-type fatty acid–binding protein levels in blood for the early identification of myocardial infarction. Methods We measured heart-type fatty acid–binding protein levels in 371 consecutive patients with acute chest pain and suspected myocardial infarction, and compared the performance of this test with those of troponin T and myoglobin tests. Levels of heart-type fatty acid–binding protein ≥6.2 ng/mL were considered as positive results. Results A final diagnosis of acute myocardial infarction was made in 181 patients (49%). Of the 68 patients who presented within 2 hours of the onset of symptoms, 37 (54%) had a final diagnosis of myocardial infarction. The sensitivity of the rapid heart-type fatty acid–binding protein test was 89% (33/37), significantly higher than for troponin T (22% [8/37]; P<0.001) and myoglobin (38% [14/37]; P<0.001). However, the specificity of troponin T (94% [29/31]) was significantly better than for heart-type fatty acid–binding protein (52% [16/31]; P= 0.002) within 2 hours. The area under the receiver operating characteristic curve for heart-type fatty acid–binding protein levels was greater than that for myoglobin (0.72 vs. 0.61, P = 0.01) among patients who presented within 2 hours. Conclusion A novel whole blood rapid heart-type fatty acid–binding protein test can be useful in the early evaluation of patients who present with acute chest pain.

A rapid troponin I assay is not optimal for determination of troponin status and prediction of subsequent cardiac events at suspicion of unstable coronary syndromes

Background: Troponin is a specific marker of myocardial damage. For early prediction of coronary events in patients with suspicion of acute coronary syndromes the assay also needs to be highly sensitive. Methods and results: A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial. A quantitative troponin T analysis was later performed on blood samples obtained at randomization by a central laboratory. There was an agreement between the rapid troponin I assay and troponin T (≤/>0.1 μg/l) in 3596 (80.9%) patients. A positive rapid troponin I was identifying any elevation of troponin T (>0.01 μg/l) in 1990 patients (90.4%) whereas a negative rapid troponin I was corresponding to negative troponin T (≤0.01 μg/l) in only 1217 patients (54.2%). Patients with a positive versus negative rapid troponin I had an increased risk of death or myocardial infarction at 30 days (9.3 vs. 5.9%; odds ratio, O.R. 1.64; 95% confidence interval, 1.31–2.06). Troponin T elevation (>0.1 μg/l) provided a better (10.5 v. 4.9%, O.R. 2.26; C.I. 1.79–2.85) risk stratification. Regardless of a positive or a negative rapid troponin I, the troponin T result (>0.1 vs. ≤0.1 μg/l) stratified the patients into high and low risk of events at 30 days, (10.3 vs. 5.7%, P=0.002) and (11.5 vs. 4.8%, P<0.001), respectively. Conclusion: In a population with non-ST elevation acute coronary syndrome a positive rapid troponin I assay is a specific indicator of troponin elevation and a predictor of early outcome. However, a negative rapid troponin I is not a reliable indicator of the absence of myocardial damage and does not indicate a low risk of subsequent cardiac events.A rapid troponin I assay was performed prior to inclusion in 4447 acute coronary syndrome patients in the GUSTO-IV trial and related to a centrally analyzed quantitative troponin T test. A positive rapid troponin I was well corresponding to any elevation of troponin T (>0.01 μg/l) and predicted an unfavorable outcome at 30 days. However, a negative rapid troponin I was corresponding to troponin T ≤0.01 μg/l in only half of the patients. Troponin T >0.1 μg/l vs. ≤0.1 μg/l provided a better risk stratification than the rapid troponin I result. For patients with troponin T elevation (>0.1 μg/l) the 30 day event rate was high regardless of the rapid troponin I result.

Risk Stratification in Acute Myocardial Ischaemia: Potential Use of A Rapid Bedside Troponin T Assay

This study is to examine the use of a Rapid Troponin T test in patientsattending the Emergency Room with complaints of chest pain. The results show a strongcorrelation between time to positive developmentaf the Rapid Trapanin T lest to ELISATrapanin T. These results indicate the use of a simple to perform bedside assay ofRapid Trapanin T may be used in early risk stratification of patients presenting wilhacute coronary syndromes. &nbsp

Recalibration of the point-of-care test for CARDIAC T Quantitative with Elecsys Troponin T 3rd generation

The rapid troponin T assay CARDIAC T Quantitative was recalibrated using Elecsys Troponin T 3rd Generation as a new reference method. This paper presents the method comparisons at six centres using the new reference method. Method comparison between CARDIAC T Quantitative versus Elecsys Troponin T 3rd Generation were performed using 319 samples from patients with acute coronary syndromes. The quality of the CARDIAC T Quantitative was controlled by a daily single determination of CARDIAC Control Troponin T, and for the Elecsys Troponin T 3rd Generation, the Elecsys controls were included in each run. The results for the control materials for the CARDIAC T Quantitative were between 93% and 107% of the target values. The CV ranged from 7% to 16%. From the regression analysis, according to Bablok and Passing (y=1.07x) and the Bland and Altman plot, the bias between CARDIAC T Quantitative and Elecsys Troponin T 3rd Generation is from +6% to +7%. The correlation coefficient is 0.93, and a 3×3 comparison of the clinical efficiency yielded 92% clinical concordance between CARDIAC T Quantitative and Elecsys Troponin T 3rd Generation. In conclusion, CARDIAC T Quantitative was in good agreement with the reference and calibration method Elecsys Troponin T 3rd Generation.

Cardiac emergency triage and therapeutic decisions using whole blood rapid troponin T test for patients with suspicious acute coronary syndrome.

Emergency triage and therapeutic decisions using the recently developed whole blood rapid troponin T test were evaluated and compared with conventional electrocardiographic (ECG) diagnosis in a total of 155 patients with chest pain who visited 16 emergency outpatient clinics in the Tokyo metropolitan area. Thirty-seven patients (23.9%) had a final diagnosis of acute myocardial infarction or high-risk unstable angina requiring emergency coronary intervention and these events were defined as acute coronary syndrome. Diagnostic values using the second-generation rapid troponin T test were evaluated according to 3 time-windows in 85 patients. The sensitivity of the test was 10% for patients assessed within 3 h after the onset, 62.5% for 3-6 h after, and 75% for more than 6h, whereas conventional ECG diagnosis had 100% sensitivity at any time-window. In contrast, the specificity of the rapid troponin T test was 100%, 100%, and 97.4%, whereas that of conventional ECG diagnosis was 25%, 57.1%, and 42.2%, respectively for the 3 time-windows. The positive predictive value of ECG diagnosis was inferior to the rapid troponin T test, which reflected the prudent attitude of physicians taking ECG decisions as positive when myocardial ischemia was suspected. The diagnostic efficacy of the rapid troponin T test was remarkable in patients with the non-ST elevation type of acute coronary syndrome. A questionnaire survey on therapeutic decisions revealed that only 10% of Tokyo outpatient institutes performed prehospital thrombolytic therapy, 30-33% administered aspirin or nitrate, and 16.7% gave heparin. The rapid troponin T test is extremely useful for cardiac emergency triage and therapeutic decision making. There is a requirement for practical guidelines for the primary therapeutic decisions for patients with suspicious acute coronary syndrome.

Patient with Chest Pain of Obscure Origin: Can AMI be Recognised Early at AED? - A Review of Diagnostic Methods and a Suggested Protocol for the Local A&amp;E Department

Chest pain is a common presentation to Accident and Emergency departments (AED). There are many causes ranging from the most trivial, an example of which is costochondritis to the life-threatening examples such as acute myocardial infarction (AMI). It is not uncommon for acute myocardial infarction to present as atypical chest pain or discomfort, or non-diagnostic electrocardiogram (ECG). The various common diagnostic methods for AMI in patients with atypical chest pain are reviewed and a suggested protocol for managing patient with chest pain of obscure origin at AED is presented. The recent introduction of rapid bedside troponin assay is likely to bring a major impact on the management of atypical chest pain in future.

Usefulness of a rapid cardiac troponin I test kit in patients with non-diagnostic chest pain or elevated CK enzyme in a Coronary Care Unit

Usefulness of a rapid cardiac troponin I test kit in patients with non-diagnostic chest pain or elevated CK enzyme in a Coronary Care Unit

Time-dependent diagnostic performance of a rapid troponin T version 2 bedside test in patients with acute coronary syndromes

In a prospective trial, the diagnostic performance of the second version of the troponin T rapid assay (Trop T; cutoff 0.2 microg/L) was compared with the quantitative cardiac-specific troponin T assay (cTnT ELISA; cutoff 0.1 microg/L) and other established cardiac markers such as CK, CK-MB activity, CK-MB mass and myoglobin. Additionally, a 30-day follow-up was performed to determine the suitability of the Trop T assay and the reference markers for short-term risk stratification. Two-hundred-and-eighty-six consecutive patients with chest pain and suspected acute myocardial infarction (AMI) were enrolled in two CCU departments. Serial blood specimens were taken at admission and at 3, 6, 12, 24, 48, 72 and 96 h after admission. According to the biochemical criterion CK-MB mass, the patients were classified as having AMI in 154 patients (54%), unstable angina (UAP) in 72 patients (27%) and no evidence for acute cardiac ischemia in 55 patients (19%). Analytical method comparison of Trop T with cTnT ELISA (cutoff 0.1 microg/L) showed a good agreement, Trop T yielded only 4% false-negative and 3% false-positive results. The diagnostic performance of Trop T for the detection of AMI was only slightly inferior compared to cTnT ELISA. Beyond 12 h after admission, Trop T and cTnT ELISA maintained a sensitivity close to 100%, whereas the sensitivity of the other cardiac markers decreased sharply. The diagnostic sensitivity of Trop T for the detection of minor myocardial damage in UAP patients was the same as for cTnT ELISA. Death within 30 days' follow-up occurred only in AMI patients with a positive Trop T test result within the first 6 h after admission. The admission Trop T and cTnT ELISA were the only significant biochemical predictors of major cardiac events. In conclusion, these data show that Trop T has similar diagnostic sensitivity as cTnT ELISA and is a useful tool to confirm acute or subacute myocardial infarction. Trop T is an excellent marker in detecting minor myocardial damage in UAP patients and is suitable for short-term risk stratification.

Bedside troponin T testing is not useful for early out-of-hospital diagnosis of myocardial infarction.

A new commercially available rapid qualitative bedside immunoassay for cardiac troponin T has been developed. The aim of the study was to investigate whether this new rapid bedside cardiac troponin T assay facilitates diagnosing myocardial infarction in a pre-hospital setting. We evaluated the sensitivity and specificity of the new rapid bedside troponin T assay for myocardial infarction. In 68 patients with acute, central, crushing chest pain, who were strongly suspected of having myocardial infarction, the emergency doctor performed preclinically a bedside cardiac troponin T test. The results were compared with the diagnosis after admission to hospital, using the criteria of the World Health Organization. The diagnosis of myocardial infarction was confirmed in 16/68 (24%) patients after admission to hospital, but only in 4/16 (25%) patients with myocardial infarction was a positive result observed preclinically with this test. The result was false positive in 1/5 patients (20%). In contrast to an excellent specificity (0.98), sensitivity (0.25) of the rapid troponin T assay was poor. Thus, we conclude that this test cannot improve the distinction between myocardial infarction and angina pectoris in a pre-hospital setting.