Diagnostic Value of Cardiac STATus(TM) for Diagnosing Acute Cardiac Ischemia in Patients with Acute Chest Pain in an Emergency Settings

ABSTRACT

PURPOSE: The purpose of this study was to investigate the usefulness of a qualitative bedside test for detection of cardiac troponin I (Cardiac STATus(TM)) in evaluating patients with acute chest pain in emergency settings. MATERIAL AND METHODS: In 147 patients who had chest pain without ST-segment elevation on their electrocardiograms, we evaluated the sensitivity and the specificity of the new, rapid, bedside troponin I assay for acute myocardial infarction (AMI) and acute cardiac ischemia (ACI). Patients whose samples were taken at least 4 hours after the onset of pain were selected. RESULTS: Cardiac STATus(TM) was positive in 28 patients (19.0%). Among 31 patients with AMI, Cardiac troponin I was positive in 19 (61.3%) patients. Among 95 patients with ACI, Cardiac STATusT M was positive in 24 patients (25.3%). The results were false positive in 12/31 patients (38.7%) for AMI and in 71/119 patients (59.7%) for ACI. The negative predictive value of the Cardiac STATus(TM) was 90.5% for AMI and 65.0% for ACI. During the 30 days of follow-up, there were 4 deaths and 12 cases of non-fatal AMI. Cardiac troponin I proved to be independent predictor of cardiac events. CONCLUSION: In contrast to its excellent specificity (0.92), the sensitivity (0.61) of the Cardiac STATus(TM) assay was poor. Thus, we conclude that this test is not highly sensitive for early detection of myocardial-cell injury. Negative test results were associated with low risk, but did not allow safe discharge of patients with chest pain from the emergency setting. Positive results of Cardiac STATus(TM) were associated with unfavorable outcomes.