A novel troponin I rule-out value below the upper reference limit for acute myocardial infarction

Goorden, Susan; Engelen, Rudi A van; Wong, Liza S. M.; Ploeg, Tjeerd van der; Verdel, Gerard J. E.; Buijs, Madelon M.

doi:10.1136/heartjnl-2015-308667

Cited by 11 publications

(8 citation statements)

References 32 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The remaining 87 articles were assessed in full-text, after which 66 studies were excluded for various reasons (Figure 1). Of the 21 articles discussed in the present systematic review (Table 1), 14 studies were included in the meta-analysis with a total of 11,929 patients and an overall prevalence of AMI of 13.0% (range 3.6-56%) 17,19,20,[24][25][26][27][29][30][31][32][33]35,36…”

Section: Resultsmentioning

confidence: 99%

“…17,[20][21][22][23][24]34,35 Eleven studies used the hs-cTnT assay as part of their reference standard and were considered as high risk for incorporation bias. [20][21][22][23]25,26,28,31,32,35,36 Seven studies did not exclude STEMI patients, 16,17,25,27,29,30,33 thus raising concerns about applicability. All studies formally re-adjudicated the final diagnoses, except the study by Slagman et al 35 in which the initial clinical diagnosis was used to establish the endpoints.…”

Section: Methodological Quality Assessmentmentioning

confidence: 99%

“…Eleven studies used the hs-cTnT assay as part of their reference standard. [20][21][22][23]25,26,28,31,32,35,36 Additional characteristics of all included studies, such as the reported cut-offs and the timing of the troponin measurements for serial measurement strategies can be found in Supplementary Material Tables S2, S3 and S5.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

“…Six out of 14 studies reported the specificity of a single high baseline measurement 24,25,29,32,33,35 (Figure 4). The prevalence of AMI differed considerably between the studies, ranging from 3.6-24%.…”

Section: Single High Baseline Measurement Of Hs-ctnt For Rule-in Of Amimentioning

confidence: 99%

See 3 more Smart Citations

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

Arslan

Dedic

Boersma

et al. 2019

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

Aims: The purpose of this study was to determine (a) the ability of serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and (b) the ability of a single high baseline high-sensitivity cardiac troponin T measurement to rule in acute myocardial infarction in patients presenting to the emergency department with acute chest pain. Methods and results: Embase, Medline, Cochrane, Web of Science and Google scholar were searched for prospective cohort studies that evaluated parameters of diagnostic accuracy of serial high-sensitivity cardiac troponin T to rule out acute myocardial infarction and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction. The search yielded 21 studies for the systematic review, of which 14 were included in the meta-analysis, with a total of 11,929 patients and an overall prevalence of acute myocardial infarction of 13.0%. For rule-out, six studies presented the sensitivity of serial measurements <14 ng/l. This cut-off classified 60.1% of patients as rule-out and the summary sensitivity was 96.7% (95% confidence interval: 92.3–99.3). Three studies presented the sensitivity of a one-hour algorithm with a baseline high-sensitivity cardiac troponin T value<12 ng/l and delta 1 hour <3 ng/l. This algorithm classified 60.2% of patients as rule-out and the summary sensitivity was 98.9% (96.4–100). For rule-in, six studies reported the specificity of baseline high-sensitivity cardiac troponin T value>50 ng/l. The summary specificity was 94.6% (91.5–97.1). Conclusion: Serial high-sensitivity cardiac troponin T measurement strategies to rule out acute myocardial infarction perform well, and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction has a high specificity.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodological Quality Assessmentmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Section: Single High Baseline Measurement Of Hs-ctnt For Rule-in Of Amimentioning

confidence: 99%

See 2 more Smart Citations

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

Arslan

Dedic

Boersma

et al. 2019

European Heart Journal: Acute Cardiovascular Care

View full text Add to dashboard Cite

show abstract

“…They report that a cardiac troponin I concentration <10 ng/L or a change of <20 ng/L on serial testing had a negative predictive value for the diagnosis of myocardial infarction of 99.8% and 98.7%, respectively 1. While we agree that there are better approaches to rule out myocardial infarction than using the 99th centile upper reference limit,2 3 we have several concerns about the generalisability and application of these thresholds in clinical practice.…”

mentioning

confidence: 78%

Response: a novel troponin I rule-out value below the upper reference limit for acute myocardial infarction

Chapman

Anand

Shah

et al. 2016

Heart

View full text Add to dashboard Cite

Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome

Chapman

Lee

McAllister

et al. 2017

JAMA

205

136

View full text Add to dashboard Cite

IMPORTANCE High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain. OBJECTIVE To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome.

show abstract

A novel troponin I rule-out value below the upper reference limit for acute myocardial infarction

Abstract: Cut-off values for hs-cTnI measurements are determined which allow a similar diagnostic classification as compared with hs-cTnT. Importantly, for a rule-out paradigm this cut-off value is unmistakably lower than the upper reference limit.

Cited by 11 publications

References 32 publications

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

Response: a novel troponin I rule-out value below the upper reference limit for acute myocardial infarction

Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome

Contact Info

Product

Resources

About