Korean J Lab Med.  2011 Jul;31(3):172-178. 10.3343/kjlm.2011.31.3.172.

Diagnostic Performance of High-Sensitivity Troponin T, Myeloperoxidase, and Pregnancy-Associated Plasma Protein A Assays for Triage of Patients with Acute Myocardial Infarction

• Khan DA
• Sharif MS
• Khan FA

• KMID: 1735850
• DOI: http://doi.org/10.3343/kjlm.2011.31.3.172

Abstract

BACKGROUND
Early diagnosis is the cornerstone of management of acute myocardial infarction (AMI). We aimed to compare the diagnostic accuracy of high-sensitivity troponin T (hs-cTnT) with myeloperoxidase (MPO) and pregnancy-associated plasma protein A (PAPP-A) for early diagnosis of AMI in patients at the time of presentation to the emergency department (ED).
METHODS
We enrolled 289 patients who presented at the ED of the National Institute of Heart Disease (NIHD) Rawalpindi, Pakistan, within 4 hr of onset of chest pain. Clinical assessment, electrocardiography (ECG), and angiography were carried out. Blood samples were collected at 0, 3, 6, and 12 hr. Analyses of plasma hs-cTnT, MPO, and PAPP-A were carried out using commercial kits.
RESULTS
Out of 289 subjects who presented to the ED, we diagnosed 180 patients with coronary heart disease as having AMI (N=61) and 119 as without AMI (stable coronary artery disease, N=61; unstable angina, N=58). Compared to non-AMI patients, the patients with AMI had significantly higher levels (represented here as median [inter quartile range]) of plasma hs-cTnT (136 [39-370] vs. 12 [7-21] ng/L), MPO (906 [564-1,631] vs. 786 [351-1,299] pmol/L) and PAPP-A (5.78 [2.67-13.4] vs. 2.8 [1.8-4.9] mIU/L). Receiver operator characteristic curves (95% CI) for hs-cTnT (0.952 [0.909-0.978]) were significantly higher (P<0.001) than those for MPO (0.886 [0.830-0.929]) and PAPP-A (0.797 [0.730-0.854]), with AMI sensitivity and specificity percentages of 87% and 98% (hs-cTnT), 82% and 84% (MPO), and 65% and 87% (PAPP-A), respectively.
CONCLUSIONS
The diagnostic performance of hs-cTnT was superior to that of MPO and PAPP-A for early triage and diagnosis of AMI among patients of coronary heart disease presenting with chest pain to the ED.

Keyword

Acute myocardial infarction; Diagnostic accuracy; High-sensitivity troponin T; Myeloperoxidase; Pregnancy-associated plasma protein A

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Biological Markers/blood
Coronary Angiography
Early Diagnosis
Electrocardiography
Female
Humans
Male
Middle Aged
Myocardial Infarction/blood/*diagnosis/radiography
Peroxidase/*blood
Pregnancy-Associated Plasma Protein-A/*analysis
ROC Curve
Time Factors
Triage
Troponin T/*blood

Figure

• 

  Fig. 1 Schematic diagram showing the methodology for classification of patients.Abbreviations: AMI, acute myocardial infarction; CAD, coronary artery disease; UA, unstable angina; SCAD, stable coronary artery disease; hs-cTnT, high-sensitivity cardiac troponin T; MPO, Myeloperoxidase; PAPP-A pregnancy-associated plasma protein A.

• 

  Fig. 2 Comparison of high-sensitivity cardiac troponin, myeloperoxidase and pregnancy-associated plasma protein A levels between patients with AMI (N=61) and without AMI at admission (N=119).Abbreviations: AMI, acute myocardial infarction; MPO, Myeloperoxidase; PAPP-A, pregnancy-associated plasma protein A.

• 

  Fig. 3 Comparison of area under receiver operator characteristic curves for high-sensitivity cardiac troponin (hs-cTnT), myeloperoxidase (MPO), and pregnancy-associated plasma protein A (PAPP-A) between patients with and without AMI at presentation in the ED. P value of hs-cTnT is <0.01 when compared to MPO and PAPP-A.

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