SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

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B SURINA1 , MM KARDUM PARO1 , Z FLEGAR-MESTRIC1 , D VRHOVSKI-HEBRANG1 , K MARIC-BESIC2 , S VUJANIC2 , S KRANJCEVIC2 , D RICHTER2 , D POCANIC2 , B JAKSIC2

1Institute of Clinical Chemistry, Merkur University Hospital, Zagreb, Croatia, 2Department of Internal Medicine, Merkur university hospital, Zagreb, Croatia

Objective. Cardiac troponin (cTnI) is biochemical marker of fundamental importance in ruling in and out diagnostic strategies for acute coronary diseases, particulary when electrocardiographic findings do not allow a diagnosis. The purpose of the study was to distinguish acute myocardial infatrction (AMI) from other pathologic conditions causing cardiac muscle damage (non AMI) using a receiver operating characteristics (ROC) curve- derived cTnI cutoff as AMI decision limit. Patients and methods. Measurements of cTnI were carried out with a point of care system (Dade Behring Stratus CS Stat fluorimetric analyser) based on a solid phase Radial partitition Immunoassay (RPIA) technology on serum specimens from 155 cardiac patients from Imergency Department. The measurement of cTnI is since october 2001 under Internal Quality control Randox International Quality Assesment Scheme (Cardiac Programme) with obtained inaccuracy spreads of less than 10%. Results. 57% of patients (89 of 155) were clinicaly diagnosed as AMI. The range values in patients with AMI were 0.09 to 81.4 (median value 1.63) microgram/L while the range values in patients with non AMI were 0.07 to 6.31 (median value 0.16) microgram/L, indicating the cTnI cutoff concentration for AMI of 0.55 microgram/L with an optimal sensitivity of 83.1% and specificity of 83.6% (95% C.I.). Predictive values (PPV 87.1%, NPV 78.9%) and likelihood ratios (+LR 4.99 ;- LR 0.22) were calculated. Summary. In a prognostic testing the cTnI value of 0.08 microgram/L represents the upper reference limit of normal, values above 0.08 and below cutoff value indicate «gray zone» suggesting further clinical evaluation, but cTnI above 0.55 microgram/L establishes injury to the extent that it qualifies as AMI (ROC curve determined). Cardiac specific biochemical marker cTnI could therefore facilitate the diagnosis of AMI and other kind of cardiac damages (non AMI) if the cutoff value is set accordingly.

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