Comparison of high sensitivity troponin T and I assays in the diagnosis of non-ST elevation acute myocardial infarction in emergency patients with chest pain

Cullen, L., Aldous, S., Than, M., Greenslade, J.H., Tate, J.R., George, P.M., Hammett, C.J., Richards, A.M., Ungerer, J.P.J., Troughton, R.W., Brown, A.F.T., Flaws, D.F., Lamanna, A., Pemberton, C.J., Florkowski, C., Pretorius, C.J., Chu, K. and Parsonage, W.A. (2014) Comparison of high sensitivity troponin T and I assays in the diagnosis of non-ST elevation acute myocardial infarction in emergency patients with chest pain. Clinical Biochemistry, 47 6: 321-326. doi:10.1016/j.clinbiochem.2013.11.019

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Author Cullen, L.
Aldous, S.
Than, M.
Greenslade, J.H.
Tate, J.R.
George, P.M.
Hammett, C.J.
Richards, A.M.
Ungerer, J.P.J.
Troughton, R.W.
Brown, A.F.T.
Flaws, D.F.
Lamanna, A.
Pemberton, C.J.
Florkowski, C.
Pretorius, C.J.
Chu, K.
Parsonage, W.A.
Title Comparison of high sensitivity troponin T and I assays in the diagnosis of non-ST elevation acute myocardial infarction in emergency patients with chest pain
Journal name Clinical Biochemistry   Check publisher's open access policy
ISSN 0009-9120
1873-2933
Publication date 2014-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.clinbiochem.2013.11.019
Open Access Status Not yet assessed
Volume 47
Issue 6
Start page 321
End page 326
Total pages 6
Place of publication Philadelphia, PA, U.S.A.
Publisher Elsevier Inc.
Language eng
Subject 1308 Clinical Biochemistry
Abstract Objectives: Concentrations of troponin measured with high sensitivity troponin assays are raised in a number of emergency department (ED) patients; however many are not diagnosed with acute myocardial infarction (AMI). Clinical comparisons between the early use (2. h after presentation) of high sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) assays for the diagnosis of AMI have not been reported. Design and methods: Early (0. h and 2. h) hs-cTnT and hs-cTnI assay results in 1571 ED patients with potential acute coronary syndrome (ACS) without ST elevation on electrocardiograph (ECG) were evaluated. The primary outcome was diagnosis of index AMI adjudicated by cardiologists using the local cTnI assay results taken ≥. 6. h after presentation, ECGs and clinical information. Stored samples were later analysed with hs-cTnT and hs-cTnI assays. Results: The ROC analysis for AMI (204 patients; 13.0%) for hs-cTnT and hs-cTnI after 2. h was 0.95 (95% CI: 0.94-0.97) and 0.98 (95% CI: 0.97-0.99) respectively. The sensitivity, specificity, PLR, and NLR of hs-cTnT and hs-cTnI for AMI after 2. h were 94.1% (95% CI: 90.0-96.6) and 95.6% (95% CI: 91.8-97.7), 79.0% (95% CI: 76.8-81.1) and 92.5% (95% CI: 90.9-93.7), 4.48 (95% CI: 4.02-5.00) and 12.86 (95% CI: 10.51-15.31), and 0.07 (95% CI: 0.04-0.13) and 0.05 (95% CI:0.03-0.09) respectively. Conclusions: Exclusion of AMI 2. h after presentation in emergency patients with possible ACS can be achieved using hs-cTnT or hs-cTnI assays. Significant differences in specificity of these assays are relevant and if using the hs-cTnT assay, further clinical assessment in a larger proportion of patients would be required.
Keyword Acute myocardial infarction
Chest pain
Diagnostic accuracy
Emergency
High sensitivity troponin
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
 
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Created: Fri, 14 Mar 2014, 20:51:17 EST by Matthew Lamb on behalf of School of Medicine