Cardiac troponins I and T are proteins integral to the function of cardiac muscle. They are very sensitive markers for the detection of myocardial damage, and the ability to assay their serum levels accurately and quickly have revolutionized the concepts of minor myocardial injury and infarction. They are also powerful prognostic indicators of future adverse cardiac events. Limitations, more of troponin T than I, include decreased specificity in renal failure and skeletal muscle disease. Rapid, whole blood assays are now available that can be done at the patient's bedside. This review discusses the cardiac troponins, their biochemistry, the assays for them currently available, and their roles in the evaluation of cardiac disease in the Emergency Department (ED).

Objectives: Osteopathic medical students must take the Comprehensive Osteopathic Medical Licensing Examination (COMLEX)-USA series of examinations, but not the United States Medical Licensing Examination (USMLE-1) series. Few data are available describing the comparability of the two tests. This study sought to determine if COMLEX-1 scores could predict USMLE-1 scores among osteopathic medical students applying to an emergency medicine (EM) residency and to determine if the scores are interchangeable.Methods: This was a retrospective analysis of osteopathic medical students applying to an EM residency program in the 2005-2006 and 2006-2007 application seasons. Students were included if they took both the COMLEX-1 and the USMLE-1 examinations. Linear regression was performed and a Bland-Altman plot of the standardized mean scores of each test was created.Results: Ninety students were included. The mean (± standard deviation [SD]) COMLEX-1 score was 559.5 (±68.6), and the mean (±SD) USMLE-1 score was 207.6 (±15.5). The correlation was 0.79, with an R 2 of 62.3%. The Bland-Altman plot showed a mean difference between the standardized scores of 0, with 95% confidence intervals (CIs) of )1.28 to +1.28 standard normal units. Limitations include that this was a single center study, and only students who took both tests could be studied.Conclusions: COMLEX-1 scores predict only 62.3% of the variance in USMLE-1 scores, and the scores are not interchangeable.ACADEMIC EMERGENCY MEDICINE 2010; 17:218-220 ª

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