Validation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain.
Med J Aust. 2014 Feb 17;200(3):161-5
Authors: Parsonage WA, Greenslade JH, Hammett CJ, Lamanna A, Tate JR, Ungerer JP, Chu K, Than M, Brown AF, Cullen L
OBJECTIVES: To validate an accelerated biomarker strategy using a high-sensitivity cardiac troponin T (hs-cTnT) assay for diagnosing acute myocardial infarction (AMI) in patients presenting to the emergency department with chest pain; and to validate this strategy in combination with the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand risk stratification model.
DESIGN, SETTING AND PATIENTS: Single-centre, prospective, observational cohort study of 764 adults presenting to a tertiary hospital with symptoms of possible acute coronary syndrome between November 2008 and February 2011.
MAIN OUTCOME MEASURES: AMI or cardiac death within 24 hours of presentation (primary), and major adverse cardiac events within 30 days (secondary).
RESULTS: An elevated hs-cTnT assay result above the 99th percentile at either the 0 h or 2 h time points had sensitivity of 96.4% (95% CI, 87.9%-99.0%), specificity of 82.6% (95% CI, 79.7%-85.2%), negative predictive value of 99.7% (95% CI, 98.8%-99.9%) and positive predictive value of 30.5% (95% CI, 24.2%-37.6%) for diagnosing AMI. Compared with a traditional 6 h cardiac troponin testing strategy, the accelerated strategy led to reclassification of risk in only two patients with adverse cardiac outcomes, with no net effect on appropriate management.
CONCLUSIONS: In patients presenting with chest pain, an accelerated biomarker strategy using the hs-cTnT assay performed well in the initial diagnosis of AMI. The accelerated strategy was also effective when incorporated into a comprehensive strategy of risk stratification that included clinical and demographic factors. The time saved by this approach could have a major impact on health service delivery.
TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12610000053022.
PMID: 24528432 [PubMed - in process]