In our cohort, selective screening of patients aged >70 years, with carotid bruit, a history of cerebrovascular disease, diabetes mellitus or PVD would have reduced the screening load by 40%, with trivial impact on surgical management or neurological outcomes.

Cardiac troponin I (cTnI) is a sensitive and specific marker of acute coronary syndromes and myocardial damage. During the past few years, it has become the preferred biochemical marker of myocardial infarction. However, due to the sensitivity required for its detection, only automated systems can be used in developed countries. However, these are rather expensive and unaffordable for most laboratories in developing countries. Many manufacturers have therefore proposed rapid immunochromatographic tests to detect cTnI. The aim of this study was to assess the limit of detection (LOD) and performance of four rapid immunochromatographic tests available in Madagascar. The four tests evaluated were Hexagon Troponin, Nadal troponin I cassette, Troponitest؉, and Amicheck-Trop. Amicheck-Trop had a sensitivity and negative predictive value of about 80%, whereas for the three others, they were about 20%. The specificity of Amicheck-Trop of 87.3% was lower than the specificities of the other tests (98% to 100%). These differences were explained by the limits of detection of the tests: 0.3 to 0.4 ng/ml for Amicheck-Trop but only 1.8 to 2 ng/ml for the three other tests. It was concluded that Amicheck-Trop could be useful in the management of acute myocardial infarction or myocarditis in sparsely equipped laboratories in developing countries.Reperfusion therapy has improved the prognosis of acute myocardial infarction (AMI). Early accurate diagnosis of acute coronary syndrome (ACS) and rapid evaluation of its severity may influence the patient's prognosis. However, in many patients with acute chest pain, the electrocardiogram (ECG) findings are often equivocal in the early hours after an event, even in cases of proven infarction. In such cases, the ECG may never show the classical features of ST elevation and new Q waves. Hence, in the early stages, there is not enough evidence in these patients for clear diagnosis and risk stratification. Cardiac troponin I (cTnI) is a sensitive and specific marker of acute coronary syndromes and myocardial damage. During the past few years, it has become the preferred biochemical marker of myocardial infarction (1, 3).The introduction of very sensitive assays for cTnI now make it possible to measure cTnI even in healthy subjects (10). It has previously been shown that minor elevations of cTnI are predictive of long-term fatal outcomes not only in subjects with diagnosed cardiovascular disease (CVD) but also in subjects with no known CVD (11). The consensus of the AACC and the European Society of Cardiology is that the 99th percentile of the upper reference limit (URL) should be used as a cutoff for the diagnosis of myocardial infarction (2, 9) and that the analytical goal of the assay should be imprecision of a 10% coefficient of variation at the 99th URL percentile.This strategy supposes that only quantitative tests using automated systems can be used. However, these are rather expensive and unaffordable for most laboratories in developing countries. Many manufacturers have therefore propo...

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