Comparative assessment of rapid test and routinmethods th to measurement of cardiac markers in patients with acute chest pain

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2 Comparative assessment of rapid test and routinmethods th to measurement of cardiac markers in patients with acute chest pain *Reza Shahsavari I, Nastou Dehkourdi II and Saeid Yazdankha III I ) Assistant Professor of Clinical Biochemistry, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran.(*Corresponding Author). II ) Medical Dr, Ahvaz Junidishapur University it of Medical Sciences, Ahvaz, Iran. III) Assistant Professor of Cardiology, Faculty of medicine, Ahvaz Junidishapur University of Medical Sciences. Ahvaz, Iran.

3 Introduction Evaluation of patients with acut chest pain in emergency room is time consuming and expensive, and it often results in uncertain diagnosis because the electrocardiogram is often nondiagnostic.in many patients with chest pain, the correct diagnosis of myocardial cell injury is dependent mainly on the measurement of cardiac markers such as cardiac troponin I (ctni) and cardiac creatin kinase isoenzyme (CK-MB). How ever, routine measurement of this marker requires special laboratory equipment. A simple test permitting earlier and more-accurative diagnosis of acute myocardial infarction(ami) could significantly improve the management of suspected patient with acute chest pain.

4 The diagnostic strategy in patients with acute chest pain suspected to AMI Clinical symptoms Electrocardiographic changes The measurement of cardic markers: 1- ctni 2- CK-MB

5 Aim The purpose of this study was the evaluate the assay of ctni with one step rapid test compare to ELISA methods and measurement of CK-MB with one step rapid test compare with routin methods in acute chest pain patients suspected to acute myocardial infarction(ami).

6 Material and Methods The study population comprised 142 patient admitted to the emergency department of Imam Khomeini hospital in Ahwaz who had acute chest pain for less than 12 hours before admission. Venous blood specimen were obtained for the measurement of qualitative with one step rapid test for ctni with Acon and Golden kits and quantitative Elisa and also the measurement of CK-MB with qualitative method one step rapid test with Acon and Golden kits and quantitative assay with immunoinhibition method.

7 Comparison qualitative method one step rapid test for the measurements of CK-MB and ctni against quantitative methods Using the cut off of 1.3 unit for the Elisa test for measurement of ctni and the cut off of 25 u/l for the assay of CK-MB with immunoinhibitioni photometry method.

8 Main characteristics of the rapid test immunodiagnostics tehnology Eeasy to use Simple to handle No specific equipment Fast and quick results Low cost Storage at room temperature

9 One step rapid test t kit

13 Std. Dev = Mean = N = AGE

15 Percent Number Frequency Diagnosis Unstable angina Stable angina Acute myocardial infarction Total

16 Diagnostic assessment of rapid ctni test with Golden kit compare to Elisa method in patients with acute chest pain. Total Normal (Negative) Patient (Positive) ctni Elisa Rapid ctni Test (Golden) Patient (Positive) Normal (Negative) Total

17 The resuls of technical properties rapid ctni test Golden kit compare with Elisa method : Relative Sensitivity : 50% Relative Specificity : 98% Positive Predictive Value : 96.2% Negative Predictive Value : 77.3% False Positive : 2.1% Fasle Negative : 50%

18 Diagnostic assessment of rapid ctni test with Acon kit compare to Elisa method in patients with acute chest pain. Total Normal (Negative) Patient (Positive) ctni Elisa Rapid ctni Test (Acon) Patient (Positive) Normal (Negative) Total

19 The resuls of technical properties rapid ctni test Acon kit compare with Elisa method : Relative Sensitivity : 51.9% Relative Specificity : 96.6% 6% Positive Predictive Value : 90% Negative Predictive Value : 79.4% False Positive : 3.4% Fasle Negative : 48.1%

20 Diagnostic assessment of rapid CK-MB test with Golden kit compare to immunoinhibition photometey method in patients with acute chest pain. Total Normal (Negative) Patient (Positive) CK-MB Photometry Rapid CK-MB Test (Golden) Patient (Positive) Normal (Negative) Total

21 The resuls of technical properties rapid CK-MB test Golden kit compare with immunoinhibition photometry method : Relative Sensitivity : 69.2% Relative Specificity : 63.1% Positive Predictive Value : 41.5% Negative Predictive Value : 84.4% False Positive : 36.9% Fasle Negative : 30.8%

22 Diagnostic assessment of rapid CK-MB test with Acon kit compare to immunoinhibition photometey method in patients with acute chest pain. Total Normal (Negative) Patient (Positive) CK-MB Photometry Rapid CK-MB Test (Acon) Patient (Positive) Normal (Negative) Total

23 The resuls of technical properties rapid CK-MB test Acon kit compare with immunoinhibition photometry method : Relative Sensitivity : 69.2% Relative Specificity : 50.4% Positive Predictive Value : 34.6% Negative Predictive Value : 81.25% False Positive : 49.6% Fasle Negative : 30.8%

24 Conclusion The present results show that rapid CK-MB test of Acon and Golden kits is not sensitive and specific for acute myocardial infarction dignosis in patients with acute chest pain. The present results show that the rapid ctni test of Acon and Golden kits is very specific but not sensitive for AMI dignosis in patients with acute chest pain

25 Selected References 1. Meinertz T, Hamm C. W. Rapid testing for cardiac troponins in patients with acute chest pain in the emergency room. Eur Heart J. 1998;19: Hamm C, Goldmann B, Heeschen C, Kreymann G, Berger J, Meinertz T. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med. 1997; 337: Labugger R, Organ L, Collier C, Atar D, VanEyk JE. Extensive troponin I and T modification detected in serum from patients with acute myocardial infarction. Circulation.2000;102: Zarling EJ, Sexton H, Milnor P. Failure to diagnose acute myocardial infarction. The clinicopathologic experience at a large community hospital. JAMA.1983;250: Altinie S, Mion M, Cappelletti A, et al. Rapid Measurement of Cardiac Markers on Stratus CS. Clin Chem. 2000;46:

26 Special Thanks

Ruling out acute myocardial infarction early with two serial creatine kinase-mb mass determinations

European Heart Journal (1999) 20, 967 972 Article No. euhj.1998.1449, available online at http://www.idealibrary.com on Ruling out acute myocardial infarction early with two serial creatine kinase-mb mass