***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Diagnostic strategies with ECG and serum cardiac markers have been used to rule out acute myocardial infa rct ion in 6 to 12 hours . The present study evaluated whether a multimarker strategy that used point-of-care measurement of myoglobin , creatine kinase (CK)-MB , and troponin I could exclude acute myocardial infa rct ion in ≤3 hours . Methods and Results —We prospect ively enrolled consecutive patients ( n=817 ) in the emergency department who were evaluated for possible acute myocardial infa rct ion . In patients with nondiagnostic ECGs , we measured CK-MB , troponin I , and myoglobin with a point-of-care device at presentation and at 90 minutes , 3 hours , and 9 hours . St and ard central laboratory testing of CK-MB was done at the same time intervals , and triage decisions were made by emergency physicians who were unaware of point-of-care results . Sensitivity and negative predictive value were compared for both the multimarker , point-of-care approach and the central laboratory strategy . Sensitivity and negative predictive value for point-of-care combination of myoglobin and troponin I by 90 minutes was 96.9 % and 99.6 % , respectively . CK-MB measurements and blood sampling at 3 hours did not improve sensitivity or negative predictive value . Median time from sampling to reporting of results was 71.0 minutes for the central laboratory versus 24.0 minutes for the point-of-care device ( P < 0.001 ) . Conclusions —Acute myocardial infa rct ion can be excluded rapidly in the emergency department by use of point-of-care measurements of myoglobin and troponin I during the first 90 minutes after presentation BACKGROUND At very early stages of acute myocardial infa rct ion ( AMI ) , highly sensitive biomarkers are still lacking . AIM To evaluate the utility of human heart-type fatty acid-binding protein ( h-FABP ) for early diagnosis of AMI . DESIGN Prospect i ve diagnostic study . METHODS Consecutive patients presenting to the emergency department with chest pain or dyspnoea within 24 h of symptom onset were included . At presentation , the h-FABP test result was compared to the st and ard diagnostic work-up , including repeated ECG and troponin T measurements . Sensitivity analysis was performed for inconclusive tests . RESULTS We enrolled 280 patients presenting to hospital with a median symptom onset of 3 h ( IQR 2 - 6 h ) : 109 ( 39 % ) had AMI . At presentation , h-FABP had a sensitivity of 69 % ( 95%CI 59 - 77 ) and specificity of 74 % ( 95%CI 66 - 80 ) ; 45 tests were false-positive and 34 were false-negative . Omitting inconclusive tests increased sensitivity and specificity only slightly . AMI was identified significantly earlier by h-FABP than by troponin T ( 24 vs. 8 patients , p=0.005 ) . DISCUSSION Although h-FABP can help to detect myocardial damage at an early stage in patients with chest pain or dyspnoea , it appears unsuitable as a st and -alone test for ruling out AMI BACKGROUND The rapid and reliable diagnosis of acute myocardial infa rct ion is a major unmet clinical need . METHODS We conducted a multicenter study to examine the diagnostic accuracy of new , sensitive cardiac troponin assays performed on blood sample s obtained in the emergency department from 718 consecutive patients who presented with symptoms suggestive of acute myocardial infa rct ion . Cardiac troponin levels were determined in a blinded fashion with the use of four sensitive assays ( Abbott-Architect Troponin I , Roche High-Sensitive Troponin T , Roche Troponin I , and Siemens Troponin I Ultra ) and a st and ard assay ( Roche Troponin T ) . The final diagnosis was adjudicated by two independent cardiologists . RESULTS Acute myocardial infa rct ion was the adjudicated final diagnosis in 123 patients ( 17 % ) . The diagnostic accuracy of measurements obtained at presentation , as quantified by the area under the receiver-operating-characteristic curve ( AUC ) , was significantly higher with the four sensitive cardiac troponin assays than with the st and ard assay ( AUC for Abbott-Architect Troponin I , 0.96 ; 95 % confidence interval [ CI ] , 0.94 to 0.98 ; for Roche High-Sensitive Troponin T , 0.96 ; 95 % CI , 0.94 to 0.98 ; for Roche Troponin I , 0.95 ; 95 % CI , 0.92 to 0.97 ; and for Siemens Troponin I Ultra , 0.96 ; 95 % CI , 0.94 to 0.98 ; vs. AUC for the st and ard assay , 0.90 ; 95 % CI , 0.86 to 0.94 ) . Among patients who presented within 3 hours after the onset of chest pain , the AUCs were 0.93 ( 95 % CI , 0.88 to 0.99 ) , 0.92 ( 95 % CI , 0.87 to 0.97 ) , 0.92 ( 95 % CI , 0.86 to 0.99 ) , and 0.94 ( 95 % CI , 0.90 to 0.98 ) for the sensitive assays , respectively , and 0.76 ( 95 % CI , 0.64 to 0.88 ) for the st and ard assay . We did not assess the effect of the sensitive troponin assays on clinical management . CONCLUSIONS The diagnostic performance of sensitive cardiac troponin assays is excellent , and these assays can substantially improve the early diagnosis of acute myocardial infa rct ion , particularly in patients with a recent onset of chest pain . ( Clinical Trials.gov number , NCT00470587 . In a prospect i ve trial , the diagnostic performance of the second version of the troponin T rapid assay ( Trop T ; cutoff 0.2 microg/L ) was compared with the quantitative cardiac-specific troponin T assay ( cTnT ELISA ; cutoff 0.1 microg/L ) and other established cardiac markers such as CK , CK-MB activity , CK-MB mass and myoglobin . Additionally , a 30-day follow-up was performed to determine the suitability of the Trop T assay and the reference markers for short-term risk stratification . Two-hundred- and -eighty-six consecutive patients with chest pain and suspected acute myocardial infa rct ion ( AMI ) were enrolled in two CCU departments .  Serial blood specimens were taken at admission and at 3 , 6 , 12 , 24 , 48 , 72 and 96 h after admission . According to the biochemical criterion CK-MB mass , the patients were classified as having AMI in 154 patients ( 54 % ) , unstable angina ( UAP ) in 72 patients ( 27 % ) and no evidence for acute cardiac ischemia in 55 patients ( 19 % ) . Analytical method comparison of Trop T with cTnT ELISA ( cutoff 0.1 microg/L ) showed a good agreement , Trop T yielded only 4 % false-negative and 3 % false-positive results . The diagnostic performance of Trop T for the detection of AMI was only slightly inferior compared to cTnT ELISA . Beyond 12 h after admission , Trop T and cTnT ELISA maintained a sensitivity close to 100 % , whereas the sensitivity of the other cardiac markers decreased sharply . The diagnostic sensitivity of Trop T for the detection of minor myocardial damage in UAP patients was the same as for cTnT ELISA . Death within 30 days ' follow-up occurred only in AMI patients with a positive Trop T test result within the first 6 h after admission . The admission Trop T and cTnT ELISA were the only significant biochemical predictors of major cardiac events . In conclusion , these data show that Trop T has similar diagnostic sensitivity as cTnT ELISA and is a useful tool to confirm acute or subacute myocardial infa rct ion . Trop T is an excellent marker in detecting minor myocardial damage in UAP patients and is suitable for short-term risk stratification Background Evidence of the clinical benefit of 3-in-1 point-of-care testing ( POCT ) for cardiac troponin T ( cTnT ) , N-terminal pro-brain natriuretic peptide ( NT-proBNP ) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes ( ACS ) , heart failure ( HF ) and thromboembolic events ( TE ) is very limited . The aim of this study is to analyse the diagnostic accuracy of POCT in primary care . Methods Prospect i ve multicentre controlled trial cluster-r and omised to POCT-assisted diagnosis and conventional diagnosis ( controls ) . Men and women presenting in 68 primary care practice s in Zurich County ( Switzerl and ) with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis . A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis , and comparison of working diagnosis accuracy between the two groups . Results The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics , symptoms and pre-existing diagnoses , but differed in working diagnosis frequencies . However , the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies . Working diagnoses overall were significantly more correct in the POCT group ( 75.7 % vs 59.6 % , p = 0.002 ) , as were the working diagnoses of ACS/HF/TE ( 69.8 % vs 45.2 % , p = 0.002 ) . All three biomarker tests showed good sensitivity and specificity . Conclusion POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients .Trial registration DRKS : BACKGROUND Heart-type fatty acid-binding protein ( H-FABP ) is a heart-specific and highly sensitive biomarker for early diagnosis of acute myocardial infa rct ion ( AMI ) . We investigated the effectiveness of H-FABP for diagnosis of AMI in patients with different ethnic background and different time from symptom onset . METHODS Venous blood was withdrawn from consecutive patients with acute chest pain admitted to the First Affiliated Hospital of Xinjiang Medical University . The blood sample s were used for measurement of creatine kinase MB ( CK-MB ) and  cardiac troponin I ( cTnI ) using Beckman Coulter DC-800 analyzer , and detection of H-FABP using a one-step bedside immunotest . RESULTS Two hundred and eighty-nine patients admitted within 12h after the onset of symptoms were recruited in the study . The H-FABP  immunotest was found to have higher diagnostic accuracy than cTnI and CK-MB in patients admitted within 3h . The combination of H-FABP and cTnI was found to have the highest diagnostic accuracy ( 91 % ) among different cardiac markers and the other combinations . It gave the highest sensitivity [ 96 % ( 95 % CI : 91 - 98 % ) ] and a comparable specificity [ 84 % ( 95 % CI : 76 - 89 % ) ] to cTnI alone . CONCLUSION A cardiac panel consisting of H-FABP and troponin is recommended We compared a rapid , point-of-care multimarker protocol with a single and serial troponin I (TnI)-only protocol in 5,244 patients admitted to the emergency department with chest pain . The diagnosis of acute myocardial infa rct ion ( AMI ) was based on a doubling myoglobin level accompanied by at least a 50 % increase in the creatine kinase (CK)-MB level with no detectable TnI ; a doubling of myoglobin level together with any detectable TnI ; or a TnI level of 0.4 ng/mL ( 0.4 microg/L ) or more , irrespective of myoglobin or CK-MB results . By using these new criteria , 145 of 148 cases were positive for AMI ( positive predictive value [ PPV ] , 92.4 % ) and 3 were negative , which were also negative by the core laboratory TnI assay . Twelve confirmed non-AMI cases were positive by the new protocol , with 10 of 12 confirmed by the core laboratory as positive for TnI. The negative predictive value ( NPV ) was 99.9 % the overall diagnostic accuracy was 99.7 % . The TnI-only protocol had a sensitivity of 68.2 % with an NPV of 99.1 % . With lower TnI-only cutoffs , 4 patients had false-negative results , and a PPV of 36.4 % was observed . Our rapid multimarker protocol seems superior to a TnI-only approach for rapidly triaging patients with chest pain or AMI Objective To assess the impact of triple marker testing on patient management and the diagnostic efficiencies of different biomarker strategies examined . Design A prospect i ve r and omised trial of triple marker testing by point-of-care testing ( POCT ) ; the R and omised Assessment of Panel Assay of Cardiac markers ( RATPAC ) study . Setting Six emergency departments . Patients Low-risk patients presenting with chest pain to diagnostic assessment with a cardiac panel 
    Output:
    
The ideal POC test for the diagnosis of AMI within 6 hours after the onset of symptoms does not yet exist .
Evaluated POC tests were in general of poor method ological quality and reported too many false negatives to be considered as save for the assessment of patients suspected of AMI .
A POC test of high-sensitive troponin could possibly fill the gap in the early hours after symptom onset , especially in those with non-definitive electrocardiography