Troponin-I, myoglobin, and mass concentration of creatine kinase-MB in acute myocardial infarction

A capillary-based microfluidic chip with the merits of low cost and easy fabrication for the rapid detection of acute myocardial infarction

Point-of-care testing methods currently utilize rapid, portable, inexpensive, and multiplexed on-site detection. Microfluidic chips have become a very promising platform with broad development prospects due to their breakthrough improvement in miniaturization and integration. However, the conventional microfluidic chips still have disadvantages, such as difficulty in fabrication processing, long production time and high cost, which hinder its applications in the fields of POCT and in vitro diagnostics. In this study, a capillary-based microfluidic chip with the characteristics of low cost and easy fabrication was developed for the rapid detection of acute myocardial infarction (AMI). Several short capillaries, which were already conjugated with the capture antibodies respectively, were connected by peristaltic pump tubes and then formed the working capillary. Two working capillaries were encapsulated in the plastic shell and ready for the immunoassay. Multiplex detection of Myoglobin (Myo), cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) were chosen to demonstrate the feasibility and analytical performance of the microfluidic chip, which requires rapid and accurate detection during diagnosis and therapy for AMI. The capillary-based microfluidic chip required tens of minutes to prepared, and its cost was less than $1. The limit of detection (LOD) was 0.5 ng/mL for Myo, 0.1 ng/mL for cTnI and 0.5 ng/mL for CK-MB respectively. The capillary-based microfluidic chips with easy fabrication and low cost hold promise for the portable and low-cost detection of target biomarkers.

Synthesis of Fluorescent Titanium Nanoclusters at ambient temperature for highly sensitive and selective detection of Creatine Kinase MM in myocardial infarction

Fluorescent-based biosensing in Photoluminescence nanomaterials has emerged as a new sensing platform commonly used for disease diagnosis. However, the synthesis of Titanium nanoclusters is highly challenging since Titanium is easily oxidized into TiO₂ at ambient temperature. To overcome this problem, we used an acidic medium and simple and robust protocol to synthesize the Titanium nanoclusters of 3-4 nm diameter, which could report the first fluorescent Titanium nanoclusters. New approaches for the novel synthesis of TiNCs can be used for rapid sensing of myocardial infarction (cardiac arrest). In converting creatine to phosphocreatine, CK-MM activates the reaction to convert ATP to ADP, thereby releasing the phosphate groups. Titanium nanoclusters bind strongly to the phosphate group and then quench the Fluorescence. Thus, this phenomenon can be further applied for quantification approaches. The quenching of fluorescence intensity with CK-MM concentration is linear with R² = 0.9829. The current approach can be applied for CK-MM sensing for a wide concentration range (0.625 U/L - 10 U/L). The detection limit was 0.2513 ng/ml in aqueous medium and 0.3465 ng/ml in human serum with high sensitivity when compared with the previous reported methods. Also, this is the first fluorescent-based sensing method to detect CK- MM. The fluorescent TiNCs is a novel platform to be widely applied for the phosphopeptide and phosphoprotein analysis due to the strong and covalent bondings between Ti with P atoms in the near future in medicine, biomedicine, and biological fields.

Graphene Quantum Dots-Based Electrochemical Biosensing Platform for Early Detection of Acute Myocardial Infarction

Heart failure resulting from acute myocardial infarction (AMI) is an important global health problem. Treatments of heart failure and AMI have improved significantly over the past two decades; however, the available diagnostic tests only give limited insights into these heterogeneous conditions at a reversible stage and are not precise enough to evaluate the status of the tissue at high risk. Innovative diagnostic tools for more accurate, more reliable, and early diagnosis of AMI are urgently needed. A promising solution is the timely identification of prognostic biomarkers, which is crucial for patients with AMI, as myocardial dysfunction and infarction lead to more severe and irreversible changes in the cardiovascular system over time. The currently available biomarkers for AMI detection include cardiac troponin I (cTnI), cardiac troponin T (cTnT), myoglobin, lactate dehydrogenase, C-reactive protein, and creatine kinase and myoglobin. Most recently, electrochemical biosensing technologies coupled with graphene quantum dots (GQDs) have emerged as a promising platform for the identification of troponin and myoglobin. The results suggest that GQDs-integrated electrochemical biosensors can provide useful prognostic information about AMI at an early, reversible, and potentially curable stage. GQDs offer several advantages over other nanomaterials that are used for the electrochemical detection of AMI such as strong interactions between cTnI and GQDs, low biomarker consumption, and reusability of the electrode; graphene-modified electrodes demonstrate excellent electrochemical responses due to the conductive nature of graphene and other features of GQDs (e.g., high specific surface area, π-π interactions with the analyte, facile electron-transfer mechanisms, size-dependent optical features, interplay between bandgap and photoluminescence, electrochemical luminescence emission capability, biocompatibility, and ease of functionalization). Other advantages include the presence of functional groups such as hydroxyl, carboxyl, carbonyl, and epoxide groups, which enhance the solubility and dispersibility of GQDs in a wide variety of solvents and biological media. In this perspective article, we consider the emerging knowledge regarding the early detection of AMI using GQDs-based electrochemical sensors and address the potential role of this sensing technology which might lead to more efficient care of patients with AMI.

Circulating non-coding RNAs as biomarkers in coronary artery disease

Coronary artery disease (CAD) is a leading cause of mortality worldwide. Atherosclerosis involves an interplay of different pathological mechanisms, such as progressive inflammation, abnormal lipid metabolism, and oxidative stress, and as such represents the basic pathological phenomenon underlying CAD. Atherosclerotic plaque narrows the lumen of coronary arteries, creating an ischemic environment for the heart muscle, which finally leads to clinical complications, such as acute myocardial infarction. Currently, there are no biomarkers that could predict plaque stability or major adverse cardiovascular events (MACE). Numerous functional non-coding RNA (ncRNA) species influence basic cellular functions, and as such play a role in the development and progression of CAD. Of these ncRNAs, micro RNAs (miRNAs) and long non-coding RNAs (lncRNAs) are the most investigated. Considering that ncRNAs detected in extracellular fluids can originate from different cells, circulating ncRNAs are being intensively investigated as potential biomarkers in the diagnosis and prognosis of CAD. In the following paper, we provide current insights into potential molecular mechanisms by which miRNAs and lncRNAs contribute to the pathology of CAD and discuss their potential role as biomarkers in diagnosis and prognosis of disease.

Cardiac biomarkers and detection methods for myocardial infarction

Background

A significant heart attack known as a myocardial infarction (MI) occurs when the blood supply to the heart is suddenly interrupted, harming the heart muscles due to a lack of oxygen. The incidence of myocardial infarction is increasing worldwide. A relationship between COVID-19 and myocardial infarction due to the recent COVID-19 pandemic has also been revealed.

Objective

We propose a biomarker and a method that can be used for the diagnosis of myocardial infarction, and an aptamer-based approach.

Results

For the diagnosis of myocardial infarction, an algorithm-based diagnosis method was developed using electrocardiogram data. A diagnosis method through biomarker detection was then developed.

Conclusion

Myocardial infarction is a disease that is difficult to diagnose based on the aspect of a single factor. For this reason, it is necessary to use a combination of various methods to diagnose myocardial infarction quickly and accurately. In addition, new materials such as aptamers must be grafted and integrated into new ways.

Purpose of Review

The incidence of myocardial infarction is increasing worldwide, and some studies are being conducted on the association between COVID-19 and myocardial infarction. The key to properly treating myocardial infarction is early detection, thus we aim to do this by offering both tools and techniques as well as the most recent diagnostic techniques.

Recent Findings

Myocardial infarction is diagnosed using an electrocardiogram and echocardiogram, which utilize cardiac signals. It is required to identify biomarkers of myocardial infarction and use biomarker-based ELISA, SPR, gold nanoparticle, and aptamer technologies in order to correctly diagnose myocardial infarction.

Identification of Blood-Brain Barrier-Permeable Proteins Derived from a Peripheral Organ: In Vivo and in Vitro Evidence of Blood-to-Brain Transport of Creatine Kinase

Certain proteins, such as inflammatory cytokines, that are released from injured or diseased organs are transported from the circulating blood through the blood-brain barrier (BBB) into the brain and contribute to the pathogenesis of related central nervous system dysfunctions. However, little is known about the protein transport mechanisms involved in the central nervous system dysfunctions. The aims of the present study were to identify BBB-permeable protein(s) derived from liver and to clarify their transport characteristics at the BBB. After administration of biotin-labeled liver cytosolic protein fraction to mice in vivo, we identified 9 biotin-labeled proteins in the brain. Among them, we focused here on creatine kinase (CK). In vitro uptake studies with human brain microvessel endothelial cells (hCMEC/D3 cells) showed preferential uptake of muscle-type CK (CK-MM) compared with brain-type CK (CK-BB) at the BBB. Integration plot analysis revealed that CK-MM readily penetrated into brain parenchyma from the circulating blood across the BBB. The uptake of CK-MM by hCMEC/D3 cells was decreased at 4 °C and in the presence of clathrin- and caveolin-dependent endocytosis inhibitors. These results indicate that entry of CK into the brain is mediated by a transport system(s) at the BBB.

Aggregation of cysteamine-capped gold nanoparticles in presence of ATP as an analytical tool for rapid detection of creatine kinase (CK-MM)

Creatine kinase, a key biomarker associated with many debilitating physiological conditions has seldom been detected in biological fluids using functionalized gold nanoparticles (GNPs). We have developed a method based on the aggregation of cysteamine (Cys) functionalized GNPs in presence of ATP for effective detection of creatine kinase (CK-MM). Positively charged Cys-GNPs (brick red color) aggregate in presence of negatively charged ATP (blue color) but the process is prevented when CK-MM is added to the solution. The analytical response to the concentration of CK-MM is linear (R² = 0.9850). The proposed method is selective in sensing the CK-MM for a range of 5.617 × 10³ ng/ml, 0.5617 ng/ml. The limit of detection was found to be 0.569 ng/ml in solution and 0.553 ng/ml in human serum with high selectivity.

Purification and characterization of Fab fragments with rapid reaction kinetics against myoglobin

Myoglobin is an early biomarker for acute myocardial infarction. Recently, we isolated the antibody IgG-Myo2-7ds, which exhibits unique rapid reaction kinetics toward human myoglobin antigen. Antibodies with rapid dissociation kinetics are thought to be premature IgG forms that are produced during the early stage of in vivo immunization. In the present study, we identified the epitope region of the IgG-Myo2-7ds antibody to be the C-terminal region of myoglobin, which corresponds to 144-154 aa. The Fab fragment was directly purified by papain cleavage and protein G affinity chromatography and demonstrated kinetics of an association constant of 4.02 × 10(4) M(-1) s(-1) and a dissociation constant of 2.28 × 10(-2) s(-1), which retained the unique reaction kinetics of intact IgG-Myo2-7ds antibodies. Because a rapid dissociation antibody can be utilized for antibody recycling, the results from this study would provide a platform for the development of antibody engineering in potential diagnostic areas such as a continuous monitoring system for heart disease.

Refolded scFv antibody fragment against myoglobin shows rapid reaction kinetics

Myoglobin is one of the early biomarkers for acute myocardial infarction. Recently, we have screened an antibody with unique rapid reaction kinetics toward human myoglobin antigen. Antibodies with rapid reaction kinetics are thought to be an early IgG form produced during early stage of in vivo immunization. We produced a recombinant scFv fragment for the premature antibody from Escherichia coli using refolding technology. The scFv gene was constructed by connection of the V(H)-V(L) sequence with a (Gly4Ser)3 linker. The scFv fragment without the pelB leader sequence was expressed at a high level, but the solubility was extremely low. A high concentration of 8 M urea was used for denaturation. The dilution refolding process in the presence of arginine and the redox reagents GSH and GSSH successfully produced a soluble scFv protein. The resultant refolded scFv protein showed association and dissociation values of 9.32 × 10⁻⁴ M⁻¹·s⁻¹ and 6.29 × 10⁻³ s⁻¹, respectively, with an affinity value exceeding 10⁷ M⁻¹ (k(on)/k(off)), maintaining the original rapid reaction kinetics of the premature antibody. The refolded scFv could provide a platform for protein engineering for the clinical application for diagnosis of heart disease and the development of a continuous biosensor.

Heart type fatty acid binding protein: structure, function and biosensing applications for early detection of myocardial infarction

Heart type fatty acid binding protein (HFABP) as an early marker of cardiac injury holds a promising future with studies indicating surpassing performance as compared to myoglobin. As a plasma marker, this cytoplasmic protein owing to its small size (∼15kDa) and water solubility, appears readily in the blood-stream following cardiomyocyte damage, reaching peak levels within 6h of symptom onset. Low plasma levels of HFABP as compared to tissue levels indicate that minute amounts of the protein when released during myocardial infarction leads to a greater proportional rise. These parameters of kinetic release make it an ideal candidate for rapid assessment of acute myocardial infarction (AMI). The need for development of rapid immunoassays and immunotests so as to use HFABP as an early marker for AMI exclusion is tremendous. In the present review, we outline the various immunoassays and immunosensors developed so far for the detection of HFABP in buffer, plasma or whole blood. The principles behind the detection techniques along with their performance parameters compared to standard ELISA techniques are elucidated.

Highly sensitive detection of human cardiac myoglobin using a reverse sandwich immunoassay with a gold nanoparticle-enhanced surface plasmon resonance biosensor

A highly sensitive reverse sandwich immunoassay for the detection of human cardiac myoglobin (cMb) in serum was designed utilizing a gold nanoparticle (AuNP)-enhanced surface plasmon resonance (SPR) biosensor. First, a monoclonal anti-cMb antibody (Mab1) was covalently immobilized on the sensor surface. AuNPs were covalently conjugated to the second monoclonal anti-cMb antibody (Mab2) to form an immuno-gold reagent (Mab2-AuNP). The reverse sandwich immunoassay consists of two steps: (1) mixing the serum sample with Mab2-AuNP and incubation for the formation of cMb/Mab2-AuNP complexes and (2) sample injection over the sensor surface and evaluation of the Mab1/cMb/Mab2-AuNP complex formation, with the subsequent calculation of the cMb concentration in the serum. The biosensor signal was amplified approximately 30-fold compared with the direct reaction of cMb with Mab1 on the sensor surface. The limit of detection of cMb in a human blood serum sample was found to be as low as 10 pM (approx. 0.18 ng mL(-1)), and the inter-assay coefficient of variation was less than 3%. Thus, the developed SPR-based reverse sandwich immunoassay has a sensitivity that is sufficient to measure cMb across a wide range of normal and pathological concentrations, allowing an adequate estimation of the disease severity and the monitoring of treatment.

Copeptin as a prognostic factor for major adverse cardiovascular events in patients with coronary artery disease

BACKGROUND

C-terminal portion of provasopressin (copeptin) has recently been discussed as a novel biomarker for the early rule-out of acute myocardial infarction (AMI). The aim is to investigate the prognostic value of copeptin with regard to mortality and morbidity in patients with symptomatic coronary artery disease (CAD).

METHODS

We consecutively recruited a cath lab cohort of 2,700 patients (74.1% male; AMI, n=1316; stable angina pectoris, n=1384) presenting to the emergency department of a large primary care hospital. All patients received coronary angiography. Copeptin and other laboratory markers were sampled at the time of presentation or in the cath lab. Clinical outcomes were assessed by hospital chart analysis and telephone interviews. 2621 patients (97.1%) have been successfully followed-up at three months. The primary endpoint was a combined endpoint of rehospitalization for cardiovascular events, stroke, and all-cause death.

RESULTS

Using receiver operating characteristic curves, we calculated areas under the curve of 0.703 (95%confidence interval(CI):0.681-0.725) for the composite endpoint after three months (myocardial reinfarction, stroke, all-cause death;n=183), and 0.770 (95%CI:0.736-0.803) for all-cause death (n=76) for copeptin. A cutoff value of 21.6 pmol/L for the composite endpoint yielded a sensitivity of 56.3% and a specificity of 78.6%. The predictive performance of copeptin was independent of other clinical variables or cardiovascular risk factors, and superior to that of troponin I or other cardiac biomarkers (all:P<0.0001).

CONCLUSIONS

Copeptin may help in the prediction of major adverse cardiovascular events in patients with symptomatic CAD. Further studies should substantiate the findings and support the suggested cutoff value of the present study.

Biomonitors of cardiac injury and performance: B-type natriuretic peptide and troponin as monitors of hemodynamics and oxygen transport balance

Serum biomarkers, such as B-type natriuretic peptide and troponin, are frequently measured in the cardiac intensive care unit. A review of the evidence supporting monitoring of these biomarkers is presented.

DESIGN

A search of MEDLINE, PubMed, and the Cochrane Database was conducted to find literature regarding the use of B-type natriuretic peptide and troponin in the cardiac intensive care setting. Adult and pediatric data were considered.

RESULTS AND CONCLUSION

Both B-type natriuretic peptide and troponin have demonstrated utility in the intensive care setting but there is no conclusive evidence at this time that either biomarker can be used to guide inpatient management of children with cardiac disease. Although B-type natriuretic peptide and troponin concentrations can alert clinicians to myocardial stress, injury, or hemodynamic alterations, the levels can also be elevated in a variety of clinical scenarios, including sepsis. Observational studies have demonstrated that perioperative measurement of these biomarkers can predict postoperative mortality and complications.

RECOMMENDATION AND LEVEL OF EVIDENCE

(class IIb, level of evidence B): The use of B-type natriuretic peptide and/or troponin measurements in the evaluation of hemodynamics and postoperative outcome in pediatric cardiac patients may be beneficial.

Histamine blood concentration in ischemic heart disease patients

The aim of this study was to investigate histamine blood concentration in subjects suffering from different types of ischemic heart diseases during the period of eight days. Our results showed that the histamine blood level was associated with different types of ischemic heart diseases. The blood histamine level in all investigated patients was significantly higher when compared to control subjects (44.87 ± 1.09 ng mL⁻¹), indicating the increase of histamine release in patients suffering from coronary diseases. In patients suffering from ACS-UA and ACS-STEMI, the second day peak of histamine level occurs (90.85 ± 6.34 ng mL⁻¹ and 121.7 ± 6.34 ng mL⁻¹, resp.) probably as the reperfusion event. Furthermore, our data suggest that histamine can be additional parameter of myocardial ischemia along with cardiac specific enzymes and may prove to be an excellent single prognostic marker for multitude of ischemic heart diseases.

Directed immobilization of reduced antibody fragments onto a novel SAM on gold for myoglobin impedance immunosensing

The successful construction of an immunosensor depends on having an effective procedure for immobilising the bio-recognition element to the transducer surface. In the present study, an amino-terminated 4-aminothiophenol (ATP) self-assembled monolayer (SAM) was modified with heterobifunctional crosslinker sulfosuccinimidyl 4-[N-maleimidomethyl] cyclohexane-1-carboxylate to couple reduced anti-myoglobin half-antibody fragments. The disulphide groups present in the hinge region of IgG molecules were selectively cleaved by 2-mercaptoethylamine to produce reduced half-antibody fragments with free sulphydryl groups. The maleimide terminated 4-ATP SAM modified surface was coupled to these reduced antibody fragments to produce highly oriented immobilization of the half-antibody via its Fc domain and to allow free access to the Fv bindings sites. This represents an improvement by comparison with biotin/avidin mediated IgG attachment which is essentially randomly oriented. Functional immunosensors were able to detect myoglobin in both phosphate buffered saline and whole serum over the range of concentrations from 10(-13)M to 10(-6)M, and order of magnitude better than avidin/biotin linked immunosensors. In addition, atomic force microscopy (AFM) was carried out to elucidate the nanotopology of the immunosensor surface at different stages of fabrication; the images demonstrate that half antibodies bind as described and show structural changes on subsequent antigen binding.

Oxygen-regulated protein 150 and prognosis following myocardial infarction

ORP150 (oxygen-regulated protein 150) is a chaperonin expressed in tissues undergoing hypoxic or endoplasmic reticulum stress. In the present study, we investigated plasma levels of ORP150 in patients with AMI (acute myocardial infarction) and its relationship with prognosis, together with a known risk marker N-BNP (N-terminal pro-B-type natriuretic peptide). Plasma from 396 consecutive patients with AMI was obtained for measurement of ORP150 and N-BNP. Mortality and cardiovascular morbidity (acute coronary syndromes/heart failure) was determined during follow-up. A specific ORP150 assay detected the 150 kDa protein in plasma extracts, including 3 and 7 kDa fragments. During follow-up (median, 455 days), 43 (10.9%) patients died. Both N-BNP and ORP150 levels were higher in those who died compared with the survivors [N-BNP, 724 (14.5-28840) compared with 6167 (154.9-33884) pmol/l (P<0.0005); ORP150, 257 (5.9-870.9) compared with 331 (93.3-831.8) pmol/l (P<0.001); values are medians (range)]. In a Cox regression model for mortality prediction, both N-BNP (odds ratio, 5.06; P<0.001) and ORP150 (odds ratio, 2.39; P<0.01) added prognostic information beyond creatinine and the use of thrombolytics. A Kaplan-Meier survival analysis revealed that ORP150 added prognostic information to N-BNP, especially in those with supra-median N-BNP levels. A simplified dual-marker approach with both markers below and either above or both above their respective medians effectively stratified mortality risk (log rank statistic for trend, 32.7; P<0.00005). ORP150 levels were not predictive of other cardiovascular morbidity (acute coronary syndromes or heart failure). In conclusion, ORP150 and peptide fragments derived from it are secreted following AMI and provide independent prognostic information on mortality. High levels associated with endoplasmic reticulum/hypoxic stress predict a poor outcome.

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

BACKGROUND AND OBJECTIVES

The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation.

PATIENTS AND METHODS

The present study was carried out on 30 PEM infants (16 nonedematous - 14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were re-evaluated using the same preinterventional parameters.

RESULTS

The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera.

CONCLUSION

We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.

Beckman Access versus the Bayer ACS:180 and the Abbott AxSYM cardiac Troponin-I real-time immunoassays: an observational prospective study

Background

Reliability of cardiac troponin-I assays under real-time conditions has not been previously well studied. Most large published cTnI trials have utilized protocols which required the freezing of serum (or plasma) for delayed batch cTnI analysis. We sought to correlate the presence of the acute ischemic coronary syndrome (AICS) to troponin-I values obtained in real-time by three random-mode analyzer immunoassay systems: the Beckman ACCESS (BA), the Bayer ACS:180 (CC) and the Abbott AxSYM (AX).

Methods

This was an observational prospective study at a university tertiary referral center. Serum from a convenience sampling of telemetry patients was analyzed in real-time for troponin-I by either the BA-CC (Arm-1) or BA-AX (Arm-2) assay pairs. Presence of the AICS was determined retrospectively and then correlated with troponin-I results.

Results

100 patients were enrolled in Arm-1 (38 with AICS) and 94 in Arm-2 (48 with AICS). The BA system produced 51% false positives in Arm-1, 44% in Arm-2, with negative predictive values of 92% and 100% respectively. In Arm-1, the BA and the CC assays had sensitivities of 97% and 63% and specificities of 18% and 87%. In Arm-2, the BA and the AX assays had sensitivities of 100% and 83% and specificities of 11% and 78%.

Conclusions

In real-time analysis, the performance of the AxSYM and ACS:180 assay systems produced more accurate troponin-I results than the ACCESS system.