Research Article| Volume 17, ISSUE 4, P625-654, December 1997

An Overview and Ranking of Biochemical Markers of Cardiac Disease

Strengths and Limitations
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      Much of the published evidence regarding the use of biochemical markers in the acute coronary syndromes is contradictory, misleading, incomplete, and unsatisfactory. There are several problems relating to analyzer calibration, reference ranges, decision thresholds, diagnostic groupings, practice guidelines, and diagnostic gold standards. In addition, much more rigor needs to be applied to test assessments, test use, and economic and decision analysis.
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        • Akagi M.
        • Nagake Y.
        • Ichikawa H.
        • et al.
        Myocardial troponin T levels in patients with diabetic nephropathy.
        Nippon Jinzo Gakkai Shi. 1996; 38: 136
        • Antman E.M.
        • Braunwald E.
        Acute myocardial infarction.
        in: Braunwald E. Heart Disease. WB Saunders, A Textbook of Cardiovascular Medicine, ed 5., Philadelphia1997: 1184-1288
        • Antman E.M.
        • Grudzien C.
        • Sacks D.B.
        Evaluation of a rapid bedside assay for detection of serum cardiac troponin T.
        JAMA. 1995; 273: 1279
        • Antman E.M.
        • Tanasijevic M.J.
        • Thompson B.
        • et al.
        Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes.
        N Engl J Med. 1996; 335: 1342
        • Apple F.
        • Dahlmeier B.
        • Sharkey S.
        Serum cardiac troponin I and T concentrations in end stage renal disease, type 1 diabetes patients [abstract].
        Clin Chem. 1995; 41: S167
        • Apple F.S.
        • Henry T.D.
        • Berger C.R.
        • et al.
        Early monitoring of serum cardiac troponin I for assessment of coronary reperfusion following thrombolytic therapy.
        Am J Clin Pathol. 1996; 105: 6
        • Baum H.
        • Obst M.
        • Huber U.
        • et al.
        Cardiac troponin T in patients with high creatinine concentration but normal creatine kinase activity in serum [technical brief].
        Clin Chem. 1996; 42: 474
        • Bennett W.M.
        • Kloster F.
        • Rosch J.
        • et al.
        Natural history of asymptomatic coronary arteriographic lesions in diabetic patients with end-stage renal diseases.
        Am J Med. 1978; 65: 779
        • Bertsch T.
        • Resch S.
        Differentialdiagnotische bedeutung von troponin T im serum: Myokardinfarkt, rhabdomyolyse oder niereninsuffizienz?.
        Dtsch Med Wochenschr. 1995; 120: 1392
        • Bhayana V.
        • Cohoe S.
        • Leung F.Y.
        • et al.
        Diagnostic evaluation of the assays for creatine kinase-2 mass and creatine kinase-3 and -2 isoform ratios in the early diagnosis of acute myocardial infarction.
        Clin Chem. 1993; 39: 488
        • Bhayana V.
        • Gougoulias T.
        • Cohoe S.
        • et al.
        Discordance between results for serum troponin T and troponin I in renal disease [case report].
        Clin Chem. 1995; 41: 312
        • Bodor G.S.
        • Porterfield D.
        • Voss E.M.
        • et al.
        Cardiac troponin-I is not expressed in fetal and healthy or diseased adult human skeletal muscle tissue.
        Clin Chem. 1995; 41: 1710
        • Braun S.L.
        • Baum H.
        • Neumeier D.
        • et al.
        Troponin T and troponin I after coronary artery bypass grafting: Discordant results in patients with renal failure [letter].
        Clin Chem. 1996; 42: 781
      1. Braunwald E, Mark DB, Jones RH, et al: Unstable Angina: Diagnosis and Management. Clinical Practice Guideline Number 10 (amended). AHCPR Publication No. 94- 0602. Rockville, MD, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute, Public Health Service, US Department of Health and Human Services, 1994

        • Briggs A.
        • Sculpher M.
        Sensitivity analysis in economic evaluation: A review of published studies.
        Health Econ. 1995; 4: 355
        • Briggs A.
        • Sculpher M.
        • Buxton M.
        Uncertainty in the economic evaluation of health care technologies: The role of sensitivity analysis.
        Health Econ. 1994; 3: 95
      2. Cochrane Methods Working Group on Systematic Review of Screening and Diagnostic Tests: Recommended methods, updated 6 June 1996 [abstract]

        • Collinson P.O.
        • Gerhardt W.
        • Katus H.A.
        • et al.
        Multicentre evaluation of an immunological rapid test for the detection of troponin T in whole blood samples.
        Eur J Clin Chem Clin Biochem. 1996; 34: 591
        • Collinson P.O.
        • Stubbs P.J.
        • Rosalki S.B.
        Cardiac troponin T in renal disease [letter].
        Clin Chem. 1995; 41: 1671
        • Collinson P.O.
        • Thomas S.
        • Siu L.
        • et al.
        Rapid troponin T measurement in whole blood for detection of myocardial damage.
        Ann Clin Biochem. 1995; 32: 454
        • Croitoru M.
        • Taegtmeyer H.
        Spurious rises in troponin T in end-stage renal disease [letter].
        Lancet. 1995; 346: 974
        • Davies M.J.
        The contribution of thrombosis to the clinical expression of coronary atherosclerosis.
        Thromb Res. 1996; 82: 1
        • Davies M.J.
        The composition of coronary-artery plaques [editorial].
        N Engl J Med. 1997; 336: 1312
        • de Lemos J.A.
        • Hillis L.D.
        Diagnosis and management of coronary artery disease in patients with end-stage renal disease on hemodialysis.
        J Am Soc Nephrol. 1997; 7: 2044
        • de Winter R.J.
        • Koster R.W.
        • van Straalen J.P.
        • et al.
        Critical difference between serial measurements of CK-MB mass to detect myocardial damage.
        Clin Chem. 1997; 43: 338
        • Detsky A.S.
        • Naglie I.G.
        A clinician's guide to cost-effectiveness analysis.
        Ann Intern Med. 1990; 113: 147
        • Drummond M.F.
        Principles of Economic Appraisal in Health Care.
        Oxford, Oxford Medical Publications1980
        • Escalon J.C.
        • Wong S.S.
        False positive cardiac troponin T levels in chronic hemodialysis patients.
        Cardiology. 1996; 87: 268
        • Foley R.N.
        • Parfrey P.S.
        • Harnett J.D.
        • et al.
        Clinical and echocardiographic disease in patients starting end-stage renal disease therapy.
        Kidney Int. 1995; 47: 186
        • Frankel W.
        • Priem S.
        • Schlüssel K.
        • et al.
        Cardiac troponin T levels are elevated in asymptomatic patients with chronic renal failure [abstract].
        Am J Clin Pathol. 1995; 104: 216
        • Frankel W.L.
        • Herold D.A.
        • Ziegler T.W.
        • et al.
        Cardiac troponin T is elevated in asymptomatic patients with chronic renal failure.
        Am J Clin Pathol. 1996; 106: 118
      3. Gerhardt W, Ljungdahl L: Detection of myocardial damage by serial determinations of cardiac troponin T, CK-MB mass, and TROPT rapid test strip. Cardio vase Drugs Ther, in press

      4. Gerhardt W, Ljungdahl L: Troponin T. A sensitive and specific diagnostic and prognostic marker of myocardial damage. Clin Chim Acta, in press

        • Gerhardt W.
        • Ljungdahl L.
        • Herbert A.K.
        Troponin-T and CK-MB (mass) in early diagnosis of ischemic myocardial injury.
        The Helsingborg study, 1992. Clin Biochem. 1993; 26: 231
        • Gibler W.B.
        • Runyon J.P.
        • Levy R.C.
        • et al.
        A rapid diagnostic and treatment center for patients with chest pain in the Emergency Department.
        Ann Emerg Med. 1995; 25: 1
        • Gill T.M.
        • Feinstein A.R.
        A critical appraisal of the quality of quality-of-life measurements.
        JAMA. 1994; 272: 619
      5. Glatz JFC, van der Vusse GJ, Simoons ML, et al: Fatty acid-binding protein and the early detection of acute myocardial infarction. Clin Chim Acta, in press

        • Goldman L.
        Using prediction models and cost-effectiveness analysis to improve clinical decisions: Emergency department patients with acute chest pain.
        Proc Assoc Am Physicians. 1995; 107: 329
        • Gray J.A.M.
        Evidence-based Healthcare.
        New York, Churchill Livingstone1997
        • Green S.
        • Onoroski M.
        • Moore R.
        • et al.
        Use of proposed CK-MB standardization material for calibration of mass measurements: Clinical correlation of patient sera [abstract].
        Clin Chem. 1993; 39: 1269
        • Green T.R.
        • Golper T.A.
        • Swenson R.D.
        • et al.
        Diagnostic value of creatine kinase and creatine kinase MB isoenzyme in chronic hemodialysis patients: A longitudinal study.
        Clin Nephrol. 1986; 25: 22
        • Hackett D.
        • Davies G.
        • Chierchia S.
        • et al.
        Intermittent coronary occlusion in acute myocardial infarction.
        Value of combined thrombolytic and vasodilator therapy. N Engl J Med. 1987; 317: 1055
        • Hafner G.
        • Thome-Kromer B.
        • Schaube J.
        • et al.
        Cardiac troponins in serum in chronic renal failure [letter].
        Clin Chem. 1994; 40: 1790
        • Hafner G.
        • Thome-Kromer B.
        • Schaube J.
        • et al.
        Response to letter of Katus et al [letter].
        Clin Chem. 1995; 41: 1202
        • Hamm C.W.
        • Ravkilde J.
        • Gerhardt W.
        • et al.
        The prognostic value of serum troponin T in unstable angina.
        N Engl J Med. 1992; 327: 146
        • Henderson A.R.
        Assessing test accuracy and its clinical consequences: A primer for receiver operating characteristic curve analysis [review].
        Ann Clin Biochem. 1993; 30: 521
      6. Henderson AR: Prefatory remarks to the roundtable on the use of biochemical markers in ischaemic heart disease. Clin Chim Acta, in press

        • Henderson A.R.
        Assessment of clinical enzyme methodology: A probabilistic approach.
        Clin Chim Acta. 1997; 257: 25
      7. Henderson AR, Gerhardt W, Apple FS: Summary, with extrapolations, of a roundtable on the use of biochemical markers in the diagnosis and theory of monitoring of patients with ischaemic heart disease. Clin Chim Acta, in press

        • Henderson A.R.
        • McQueen M.J.
        • Patten R.L.
        • et al.
        Testing for creatine kinase and creatine kinase-2 in Ontario: Reference ranges and assay types.
        Clin Chem. 1992; 38: 1365
        • Henderson A.R.
        • Stark J.A.
        • McQueen M.J.
        • et al.
        Is the determination of creatine kinase- 2 after electrophoretic separation accurate?.
        Clin Chem. 1994; 40: 177
        • Henry J.
        Clinical Diagnosis and Management by Laboratory Methods.
        ed 19. WB Saunders, Philadelphia1996
        • Hossein-Nia M.
        • Nisbet J.
        • Merton G.K.
        • et al.
        Spurious rises of cardiac troponin T [letter].
        Lancet. 1995; 346: 1558
        • Jaeschke R.
        • Guyatt G.H.
        • Sackett D.L.
        • et al.
        Users' guides to the medical literature.
        III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? JAMA. 1994; 271: 703
        • Karmel W.B.
        Prevalence, incidence, and mortality of coronary heart disease.
        in: Fuster V. Ross R. Topol E.J. Atherosclerosis and Coronary Artery Disease. Lippincott-Raven, Philadelphia1996: 13-21
        • Karlson B.W.
        • Herlitz J.
        • Edvardsson N.
        • et al.
        Eligibility for intravenous thrombolysis in suspected acute myocardial infarction.
        Circulation. 1990; 82: 1140
        • Kassirer J.P.
        • Kopelman R.I.
        Learning Clinical Reasoning.
        Baltimore, Williams & Wilkins1991
        • Katus H.A.
        • Haller C.
        • Müller-Bardorff M.
        • et al.
        Cardiac troponin T in end-stage renal disease patients undergoing chronic maintenance hemodialysis [letter].
        Clin Chem. 1995; 41: 1201
        • Kazmierczak S.C.
        • Catrou P.G.
        Clinical informatics.
        Anal Chem. 1995; 67: 437R
        • Keffer J.H.
        The economic aspects of new delivery options for diagnostic testing.
        in: Kost G.J. Handbook of Clinical Automation, Robotics, and C^timization. John Wiley & Sons, New York1996: 577-595
        • Keffer J.H.
        The cardiac profile and proposed practice guideline for acute ischemic heart disease [review].
        Am J Clin Pathol. 1997; 107: 398
        • Lameire N.
        • Vanholder R.C.
        • Loo A.V.
        • et al.
        Cardiovascular diseases in peritoneal dialysis patients: The size of the problem.
        Kidney Int. 1996; 50: S-28
        • Laperche T.
        • Steg G.
        • Dehoux M.
        • et al.
        A study of biochemical markers of reperfusion early after thrombolysis for acute myocardial infarction.
        Circulation. 1995; 92: 2079
        • Lavin F.
        • Kane M.
        • Forde A.
        • et al.
        Comparison of five cardiac markers in the detection of reperfusion after thrombolysis in acute myocardial infarction.
        Br Heart J. 1995; 73: 422
        • Lee T.H.
        • Weisberg M.C.
        • Brand D.A.
        • et al.
        Candidates for thrombolysis among emergency room patients with acute chest pain.
        Potential true- and false-positive rates [see comments]. Ann Intern Med. 1989; 110: 957
        • Leung F.Y.
        • Galbraith L.V.
        • Jablonsky G.
        • et al.
        Re-evaluation of the diagnostic utility of serum total creatine kinase and creatine kinase-2 in myocardial infarction.
        Clin Chem. 1989; 35: 1435
        • Li D.
        • Jialal I.
        • Keffer J.
        Greater frequency of increased cardiac troponin T than increased cardiac troponin I in patients with chronic renal failure [letter].
        Clin Chem. 1996; 42: 114
        • Li D.
        • Keffer J.
        • Corry K.
        • et al.
        Nonspecific elevation of troponin T levels in patients with chronic renal failure.
        Clin Biochem. 1995; 28: 474
        • Lindahl B.
        • Venge P.
        • Wallentin L.
        Early diagnosis and exclusion of acute myocardial infarction using biochemical monitoring.
        Coron Artery Dis. 1995; 6: 321
        • Lindahl B.
        • Venge P.
        • Wallentin L.
        • et al.
        Relation between troponin T and the risk of subsequent cardiac events in unstable coronary artery disease.
        Circulation. 1996; 93: 1651
        • Littenberg B.
        • Moses L.E.
        Estimating diagnostic accuracy from multiple conflicting reports: A new meta-analytic method.
        Med Decis Making. 1993; 13: 313
        • Mach F.
        • Lovis C.
        • Chevrolet J.
        • et al.
        Rapid bedside whole blood cardiospecific troponin T immunoassay for the diagnosis of acute myocardial infarction.
        Am J Cardiol. 1995; 75: 842
      8. Mair J: Glycogen phosphorylase isoenzyme BB to diagnose ischemic myocardial injury. Clin Chim Acta, in press

        • Mair J.
        • Smidt J.
        • Lechleitner P.
        • et al.
        Rapid accurate diagnosis of acute myocardial infarction in patients with non-traumatic chest pain within lh of admission.
        Coron Artery Dis. 1995; 6: 539
        • Mair J.
        • Smidt J.
        • Lechleitner P.
        • et al.
        A decision tree for the early diagnosis of acute myocardial infarction in nontraumatic chest pain patients at hospital admission [see comments].
        Chest. 1995; 108: 1502
        • Manske C.L.
        • Thomas W.
        • Wang Y.
        • et al.
        Screening diabetic transplant candidates for coronary artery disease: Identification of a low risk subgroup.
        Kidney Int. 1993; 44: 617
        • Mark D.B.
        • Jones R.H.
        The national clinical practice guidelines for unstable angina.
        in: Califf R.M. Mark D.B. Wagner G.S. Acute Coronary Care. ed 2. Mosby, St. Louis1995: 503-523
        • McLaurin M.D.
        • Apple F.S.
        • Voss E.M.
        • et al.
        Cardiac troponin I, cardiac troponin T, and CK-MB in dialysis patients without ischemic heart disease: Evidence of cardiac troponin T expression in skeletal muscle.
        Clin Chem. 1997; 43: 976
        • Medeiros L.J.
        • Gerson B.
        Prognostic significance of creatine kinase MB isoenzyme in serum of patients with renal failure [letter].
        Clin Chem. 1985; 31: 1772
        • Moses L.E.
        • Shapiro D.
        • Littenberg B.
        Combining independent studies of a diagnostic test into a summary ROC curve: Data-analytic approaches and some additional considerations.
        Stat Med. 1993; 12: 1293
        • Müller-Bardorff M.
        • Freitag H.
        • Scheffold T.
        • et al.
        Development and characterization of a rapid assay for bedside determinations of cardiac troponin T.
        Circulation. 1995; 92: 2869
        • Müller-Bardorff M.
        • Hallermayer K.
        • Schröder A.
        • et al.
        Improved troponin T ELISA specific for the cardiac troponin T isoform.
        Clin Chem. 1997; 43: 458
        • Naylor D.
        Cost-effectiveness analysis: Are the outputs worth the inputs? [editorial].
        ACP J Club. 1996; 124: A-12
        • Nease R.F.
        • Kneeland T.
        • O'Connor G.T.
        • et al.
        Variation in patient utilities for outcomes of the management of chronic stable angina.
        Implications for clinical practice guidelines. JAMA. 1995; 273: 1185
        • Norris R.M.
        • Johnson R.N.
        • White H.D.
        • et al.
        Non-invasive diagnosis of infarct artery patency after acute myocardial infarction by use of serial plasma troponin T concentrations: Importance of measurement of peak levels.
        Heart. 1996; 75: 481
        • Nosanchuk J.S.
        • Keefner R.
        Cost analysis of point-of-care laboratory testing in a community hospital.
        Am J Clin Pathol. 1995; 103: 240
        • Ohman E.M.
        • Armstrong P.W.
        • Christenson R.H.
        • et al.
        Cardiac troponin T levels for risk stratification in acute myocardial ischemia.
        N Engl J Med. 1996; 335: 1333
        • Ohman E.M.
        • Christenson R.H.
        • Califf R.M.
        • et al.
        Noninvasive detection of reperfusion after thrombolysis based on serum creatine kinase MB changes and clinical variables.
        Am Heart J. 1993; 126: 819
      9. Panteghini M: CK-MB mass. Clin Chim Acta, in press

        • Panteghini M.
        • Pagani F.
        Characterization of a rapid immunochromatographic assay for simultaneous detection of high concentrations of myoglobin and CK-MB in whole blood.
        Clin Chem. 1996; 42: 1292
        • Pettersson T.
        • Ohlsson O.
        • Try ding N.
        Increased CK-MB (mass concentration) in patients without traditional evidence of acute myocardial infarction.
        A risk indicator of coronary death. Eur Heart J. 1992; 13: 1387
      10. Plebani M, Zaninotto M: Diagnostic strategies using myoglobin measurement in myocardial infarction. Clin Chim Acta, in press

        • Puleo P.R.
        • Meyer D.
        • Wathen C.
        • et al.
        Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction.
        N Engl J Med. 1994; 331: 561
        • Ravkilde J.
        • Hansen A.B.
        • Horder M.
        • et al.
        Risk stratification in suspected infarction based on a sensitive immunoassay for serum creatine kinase isoenzyme MB.
        Cardiology. 1992; 80: 143
        • Ravkilde J.
        • Horder M.
        • Gerhardt W.
        • et al.
        Diagnostic performance and prognostic value of serum troponin T in suspected acute myocardial infarction.
        Scand J Clin Lab Invest. 1993; 53: 677
        • Ravkilde J.
        • Nissen H.
        • Horder M.
        • et al.
        Independent prognostic value of serum creatine kinase isoenzyme MB mass, cardiac troponin T and myosin light chain levels in suspected acute myocardial infarction.
        Analysis of 28 months of follow-up in 196 patients. J Am Coll Cardiol. 1995; 25: 574
        • Riegelman R.K.
        The Measures of Medicine.
        and Costs. Cambridge, MA, Blackwell Science, Benefits, Harms1995
        • Roberts R.
        The two out of three criteria for the diagnosis of infarction: Is it passe?.
        Chest. 1984; 86: 511
      11. Roberts R: Early diagnosis of myocardial infarction with MBCK subforms. Clin Chim Acta, in press

        • Rowley J.M.
        • Hampton J.R.
        Diagnostic criteria for myocardial infarction.
        Br J Hosp Med. 1981; 26: 253
        • Rozenman Y.
        • Gotsman M.S.
        The earliest diagnosis of acute myocardial infarction [review].
        Annu Rev Med. 1994; 45: 31
        • Ryan T.J.
        • Anderson J.L.
        • Antman E.M.
        • et al.
        ACC /AHA guidelines for the management of patients with acute myocardial infarction.
        A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1996; 28: 1328
        • Sackett D.L.
        • Haynes R.B.
        • Guyatt G.H.
        • Tugwell P.
        Clinical Epidemiology.
        Little, Brown, A Basic Science for Clinical Medicine, ed 2., Boston1991
        • Sackett D.L.
        • Richardson W.S.
        • Rosenberg W.
        • Haynes R.B.
        Evidence-based Medicine.
        How to Practice and Teach EBM. New York, Churchill Livingstone1997
        • Shultz E.K.
        Multivariate receiver-operating characteristic curve analysis: Prostate cancer screening as an example.
        Clin Chem. 1995; 41: 1248
        • Sox H.C.
        • Blatt M.A.
        • Higgins M.C.
        • Marton K.I.
        Medical Decision Making.
        Boston, Butterworths1988
        • Sperling M.
        • Chen I.W.
        • Flitman H.
        • et al.
        Serum cardiac troponin-T in patients with elevated serum creatinine concentration [abstract].
        Clin Chem. 1995; 41: S166
        • Stubbs P.
        • Collinson P.
        • Moseley D.
        • et al.
        Prognostic significance of admission troponin T concentrations in patients with myocardial infarction.
        Circulation. 1996; 94: 1291
        • Stubbs P.
        • Collinson P.
        • Moseley D.
        • et al.
        Prospective study of the role of cardiac troponin T in patients admitted with unstable angina.
        Br Med J. 1996; 313: 262
        • Timmis A.D.
        Will serum enzymes and other proteins find a clinical application in the early diagnosis of myocardial infarction?.
        Br Heart J. 1994; 71: 309
        • Udvarhelyi I.S.
        • Colditz G.A.
        • Rai A.
        • et al.
        Cost-effectiveness and cost-benefit analyses in the medical literature.
        Are the methods being used correctly? Ann Intern Med. 1992; 116: 238
        • Vaidya H.
        • Apple F.
        • Boches F.
        • et al.
        Preparation of preliminary standards for creatine kinase-MB (CK-MB) mass immunoassays [abstract].
        Clin Chem. 1993; 39: 1256
        • Weinstein M.C.
        • Fineberg H.V.
        Clinical Decision Analysis.
        Philadelphia, WB Saunders1980
        • Weinstein M.C.
        • Stason W.B.
        Foundations of cost-effective analysis for health and medical practices.
        N Engl J Med. 1977; 296: 716
      12. WHO MONICA Project, Tunstall-Pedeo H, Kuulasmaa K, et al: Myocardial infarction and coronary deaths in the World Health Organization MONICA project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90:583, 1994

        • Wians F.H.
        • Baskin L.B.
        • Keffer J.H.
        • et al.
        Evaluation and implementation of an immuno- chemiluminometric assay (ICMA) for quantifying CK-MB concentration.
        Clin Lab Sei. 1995; 8: 334
        • Wu A.H.B.
        • Feng Y.
        • Roper L.
        • et al.
        Cardiac troponins T and I before and after renal transplantation [letter].
        Clin Chem. 1997; 43: 411
        • Wu A.H.B.
        • Feng Y.J.
        • Contois J.H.
        • et al.
        Prognostic value of cardiac troponin I in patients with chest pain [letter].
        Clin Chem. 1996; 42: 651
        • Wu A.H.B.
        • Lane P.L.
        Metaanalysis in clinical chemistry: Validation of cardiac troponin T as a marker of ischemic heart disease.
        Clin Chem. 1995; 41: 1228
        • Zabel M.
        • Hohnloser S.H.
        • Köster W.
        • et al.
        Analysis of creatine kinase, CK-MB, myoglobin, and troponin T time-activity curves for early assessment of coronary artery reperfusion after intravenous thrombolysis.
        Circulation. 1993; 87: 1542
        • Zager R.A.
        Rhabdomyolysis and myohemoglobinuric acute renal failure [review].
        Kidney Int. 1996; 49: 314
        • Zweig M.H.
        • Campbell G.
        Receiver-operating characteristic (ROC) plots: A fundamental evaluation tool in clinical medicine [review].
        Clin Chem. 1993; 39: 561