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Assessment of diagnostic and prognostic accuracyTABLE 15 Population characteristics of studies of other biomarkersStudy Biomarker Study typePopulation: age(mean in years,unless stated); sex Inclusion criteria Exclusion criteriaTime fromsymptoms(hours)No. ofpatientsApple 2009 55 CD40L, MPO, MMP9,CRP, NT-pro-BNPSingle centre, USA Mean age 54; 260(57%) maleSymptoms suggestive of ACSwithin 12 hoursNR 3.1 (median) 457Bassan 2005 56 BNP Single centre, Brazil Mean age 67.3; 343maleChest pain < 12 hours dueto possible acute cardiacischaemiaST segment elevation 2.0 (median) 631Body 2011 57 BNP, MPO Single centre, UK Mean age 59; 430(61%) maleSuspected cardiac chestpain occurring within theprevious 24 hoursChest trauma, renal failurerequiring dialysis, medicalcondition necessitatingadmission, pregnancy3.5 (median) 705Body 2011 46 PAPP-A, CD40L Single centre, UK Mean age 59; 434(61%) maleSuspected cardiac chestpain occurring within theprevious 24 hoursChest trauma, renal failurerequiring dialysis, medicalcondition necessitatingadmission, pregnancy3.5 (median) 713Brown 2007 47 ST2 Single centre, US Mean age 49.8; 160(46%) maleChest pain prompting anECGNR 4.3 (median) 348Esporcatte MPO Single centre, Brazil Mean age 63.0; 762007 65 (54%) maleChest pain within 24 hours STEMI, inflammatory orinfectious syndrome, neoplasiaor the use of drugs affectingthe immune systemWithin 24 hours 140Keller 2010 71 Copeptin Multicentre,GermanyMean age 61; 920(66%) maleAged 18–85 years withangina pectoris or equivalentsymptomsTrauma or major surgerywithin the last 4 weeks,pregnancy, intravenous drugabuse, anaemia57.6%< 6 hours1386Potsch 2006 51 CRP Single centre, Brazil Mean age 64.9; 54.6%maleChest pain presenting to ED ST elevation Within 12 hours 980Reichlin Copeptin Single centre,2009 80 SwitzerlandMean age 62; 321maleSymptoms suggestive of MIwithin the last 12 hoursTerminal renal failure requiringdialysisWithin 12 hours 487Rudolph MPO Single centre,2010 81 GermanyMean age 64; 192(70%) maleChest pain presenting tothe EDNR 4.5 (median) 274NR, not reported.50NIHR Journals Library
DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 1TABLE 16 Index and reference standard tests used in studies of other biomarkersStudyIndex test analyser(timing is at presentation unlessotherwise stated) Threshold Reference test assay and timingReference Tndiagnosticthreshold (µg/l)MI prevalencein sample (%)Apple 2009 55 CD40L, R&D Systems ELISA 1.08 ng/l Dade Behring Dimension or Stratus CS TnI at 8 hoursafter presentation0.1 5Apple 2009 55 MPO, Assay Designs ELISA 125 µg/l Dade Behring Dimension or Stratus CS TnI at 8 hoursafter presentation0.1 5Apple 2009 55 MMP9, Assay Designs ELISA 233 µg/l Dade Behring Dimension or Stratus CS TnI at 8 hoursafter presentation0.1 5Apple 2009 55 CRP, Dade Behring Dimension 1.0 and 3.0 mg/l Dade Behring Dimension or Stratus CS TnI at 8 hoursafter presentation0.1 5Apple 2009 55 NT-pro-BNP, Roche Elecsys 125 ng/l age < 75 years,450 ng/l age > 75 yearsDade Behring Dimension or Stratus CS TnI at 8 hoursafter presentation0.1 5Bassan 2005 56 Biosite immunofluorescence BNP assay 100 pg/ml Dade Behring TnI; within 9 hours post-admission; 1.0 11Body 2011 57 BNP Alere Fluorescence Immunoassay 73 ng/ml cTnT; Roche Elecsys; at least 12 hours after symptomonset0.01 18Body 2011 57 MPO Alere Fluorescence Immunoassay 510 pM cTnT; Roche Elecsys; at least 12 hours after symptomonset0.01 18Body 2011 46 PAPP-A, Demeditec Diagnostics ultrasensitiveELISA4.4 µg/l Roche fourth generation TnT at 12 hours 0.035 18Body 2011 46 CD40L, R&D Systems Quantikine kit 17.2 ng/l Roche fourth-generation TnT at 12 hours 0.035 18continued© Queen’s Printer and Controller of HMSO 2013. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of Statefor Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journalsprovided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton SciencePark, Southampton SO16 7NS, UK.51
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Health Technology AssessmentVOLUME
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DOI: 10.3310/hta17010 Health Techno
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ContentsAppendix 5 Expected discoun
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Page 22 and 23: BackgroundTABLE 1 Hospital admissio
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Discussionspecificity were 62% (95%
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Discussionneed for revascularisatio
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Discussionchanges in sensitivity an
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Discussionuncertainty about these p
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Discussiontroponin assays have bett
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ConclusionsSuggested research prior
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Appendix 144. heart-type fatty acid
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Appendix 1135. interleukin 33.mp. (
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Appendix 313. Fernandez Portales JG
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Appendix 346. Luscher MS, Ravkilde
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Appendix 9Clinical diagnosis of NST
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Appendix 9respectively. Exercise EC
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Appendix 93. Two reviewers will mak
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Appendix 9The methodology used in t
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Appendix 9ES (Information Resources
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Appendix 923. Westwood ME, Whiting
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