Table 2

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study weaknesses
Mair J et al, 1995, Austria¹	114 emergency department patients with chest pain	Diagnostic test study	AMI	Sensitivity 46% on admission	Only admitted patients. Troponin cut off set at 0.032 ng/l
De Winter RJ et al, 1995, Netherlands²	309 emergency department patients with chest pain	Diagnostic test study	AMI	Sensitivity 67% in patients with less than 75% chance of AMI	Unclear if gold standard blinded. Risk assessment was by clinical judgement. Patients with abnormal ECGs included
Tucker JF et al, 1997, USA³	177 emergency department patients within 24h of onset of chest pain	Diagnostic test study	AMI	Sensitivity 33.3% at 1 h	Only admitted patients.
				Sensitivity 33.3% at 2 h
				Sensitivity 59.3% at 6 h
				Sensitivity 96.3% at 12–24 h
				Specificity 86.7% at 12–24 h
REACTT investigators, 1997, USA⁴	926 emergency department patients with chest pain	Diagnostic test study	AMI	Sensitivity 19.6% v 25% on admission	206 patients excluded because of lack of data. Discharged patients not followed up with same gold standard
				Sensitivity 59% v 69.6% at 3 h
	Rapid bedside test v laboratory test			Sensitivity 69.7% v 79.8% at 6 h
Hamm CW et al, 1997, Germany⁵	773 emergency department patients within 12 h of onset of chest pain, with no ST increase	Observational	Death or non-fatal	44% predicted on arrival	No independent gold standard applied to all patients. Inadequate follow up of discharged patients. Sensitivity could not be calculated
			AMI within30 days	79% predicted after 4 h
Moher ER et al, 1998, USA⁶	100 patients with chest discomfort	Diagnostic test study	AMI	Sensitivity 90% at 4 h	Cumulative sensitivities at 4 h.
Sayre MR et al, 1998, USA⁷	667 patients with chest pain	Diagnostic test study	AMI	Sensitivity 88% at 12 h post admission	Only admitted patients studied.
				Sensitivity 97% at 24 h post admission
Zimmermman J et al, 1999, USA⁸	955 emergency department patients with chest pain	Diagnostic test study	AMI	Sensitivity 87% at 10 h post onset
Johnson PA et al, 1999, USA⁹	1477 emergency department patients with hest pain	Diagnostic test study	AMI in the 24 h after presentation	Sensitivity 99% at 24 h	174 cases excluded
				Specificity 86% at 24 h