Abstract | BACKGROUND: Cardiac troponin is the preferred biomarker for detecting acute myocardial injury and infarction (MI). We studied whether multiple biomarkers of numerous pathophysiological pathways would increase the diagnostic accuracy for detecting MI. METHODS: RESULTS:
Biomarker sensitivities ranged from 20% to 96%, and specificities ranged from 19% to 89%. MMP-9 had the highest sensitivity, but its specificity was 19%. cTnI demonstrated a sensitivity of 72% (95% CI, 51%-88%) and a specificity of 89% (95% CI, 85%-92%). In multivariate models, cTnI (P < 0.001) and either hsCRP (P = 0.009) or MMP-9 (P = 0.03) were independently predictive of MI. Addition of hsCRP or MMP-9 increased the specificity to 95% (95% CI, 92%-97%) or 91% (95% CI, 88%-94%), respectively, but reduced the sensitivity to 56% (95% CI, 35%-76%) and 68% (95% CI, 47%-85%) relative to cTnI alone. CONCLUSIONS: Our findings indicate that the most clinically accurate biomarker for the early diagnosis of MI is the use of cTnI alone, rather than a multiple- biomarker approach, when an analytically robust cardiac troponin assay based on the 99th percentile is used.
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Authors | Fred S Apple, Stephen W Smith, Lesly A Pearce, MaryAnn M Murakami |
Journal | Clinical chemistry
(Clin Chem)
Vol. 55
Issue 1
Pg. 93-100
(Jan 2009)
ISSN: 1530-8561 [Electronic] England |
PMID | 19028826
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Biomarkers
- PGF protein, human
- Peptide Fragments
- Pregnancy Proteins
- Troponin I
- pro-brain natriuretic peptide (1-76)
- Natriuretic Peptide, Brain
- Placenta Growth Factor
- CD40 Ligand
- C-Reactive Protein
- Peroxidase
- Matrix Metalloproteinase 9
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Topics |
- Acute Coronary Syndrome
(blood, diagnosis)
- Aged
- Biomarkers
(blood)
- C-Reactive Protein
(analysis)
- CD40 Ligand
(blood)
- Enzyme-Linked Immunosorbent Assay
- Female
- Glomerular Filtration Rate
- Humans
- Logistic Models
- Male
- Matrix Metalloproteinase 9
(blood)
- Middle Aged
- Myocardial Infarction
(blood, diagnosis)
- Natriuretic Peptide, Brain
(blood)
- Peptide Fragments
(blood)
- Peroxidase
(blood)
- Placenta Growth Factor
- Pregnancy Proteins
(blood)
- Risk Assessment
- Sensitivity and Specificity
- Solubility
- Troponin I
(blood)
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