Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction

Aldous, Sally; Richards, A. Mark; George, Peter M.; Cullen, Louise; Parsonage, William; Flaws, Dylan; Florkowski, Christopher M; Troughton, Richard W.; O’Sullivan, Jack W; Reid, Christopher M.; Bannister, Laura; Than, Martin

doi:10.1016/j.ijcard.2014.09.026

Cited by 30 publications

(21 citation statements)

References 28 publications

(38 reference statements)

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“…These findings are consistent with the results of Aldous et, al. which demonstrated no significant difference in the sensitivity or specificity for MACE of an ADP when using a new generation point of care cTnI versus a hs-cTnI assay [27]. The finding from our study are significant given the current lack of availability of hs-cTn assays in the US and the concern that lack of these assays significantly hampers our ability to perform chest pain risk stratification.…”

Section: Discussionmentioning

confidence: 69%

Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Mahler

Stopyra

Apple

et al. 2017

Clinical Biochemistry

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Objectives The HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve >99% sensitivity for major adverse cardiac events (MACE) at 30 days and early discharge rates >20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. Design & Methods A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. Each patient was risk stratified by the cTn-HEART Pathway (Siemens TnI-Ultra at 0- and 3-hours) and a hs-cTn-HEART Pathway using hs-cTnI (Abbott) or hs-cTnT (Roche) at 3-hours. The early discharge rate, sensitivity, specificity, and negative predictive value (NPV) for MACE (death, myocardial infarction, or coronary revascularization) at 30 days were calculated. Results hs-cTnI measures were available on 133 patients. MACE occurred in 11/133 (8%) of these patients. Test characteristics for the HEART Pathway using serial cTnI vs 3 hour hs-cTnI were the same: sensitivity (100%, 95%CI: 72–100%), specificity (49%, 95%CI: 40–58%), NPV (100%, 95%CI: 94–100%), and early discharge rate (45%, 95%CI: 37–54%). The HEART Pathway using hs-cTnT missed one MACE event (myocardial infarction): sensitivity (91%, 95%CI: 59–100%), specificity (48%, 95%CI: 39–57%), NPV (98%, 95%CI: 91–100%), and early discharge rate (45%, 95%CI: 37–54%). Conclusions There was no difference in the test characteristics of the HEART Pathway whether using cTnI or hs-cTnI, with both achieving 100% sensitivity and NPV. Use of hs-cTnT with the HEART Pathway was associated with one missed MACE.

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Section: Discussionmentioning

confidence: 69%

Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Mahler

Stopyra

Apple

et al. 2017

Clinical Biochemistry

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“…Newer POC assays have been developed specifically for the troponin I subunit that are improved from older testing versions. 4,5 Similar studies have been carried out, but there is a divergence in results reported when POC testing is compared to laboratory testing, with most studies stating that POC testing is inferior. 6,7 Loten et al 8 compared the results in terms of experienced and inexperienced operators with their central laboratory and concluded the POC produced similar results for troponin levels.…”

Section: Discussionmentioning

confidence: 95%

Comparison of Point-of-Care Versus Laboratory Troponin Testing in an Emergency Department Setting

Juliano

Wason

2017

Military Medicine

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Background: There have been concerns regarding troponin results accuracy between point-of-care (POC) testing preformed in an emergency department (ED) setting and laboratory testing. The purpose of this study was to compare the results of cardiac troponin I testing as concerns POC testing and laboratory analysis as a way to show that these results are interchangeable. Methods: A retrospective chart review was performed from October 2012 through September 2013 to identify all patients who presented to the ED that received both a POC and laboratory troponin associated with the same blood draw. Findings: A total of 189 patients met inclusion criteria. Three laboratory samples were hemolyzed and not available for comparison. Of the remaining 186 samples, when a positive cutoff value of 0.034 ng/mL was used: 37 POC tests were positive and 149 POC tests were negative, sensitivity 0.85 (95% confidence interval [CI] = 0.69-0.94), specificity 0.98 (95% CI = 0.94-0.99), positive predictive value 91.9% (95% CI = 77-97.9%), and negative predictive value 96% (95% CI = 91.1-98.4%). When a POC troponin positive cutoff value of 0.12 ng/mL was used: 20 POC tests were positive and 164 were negative: sensitivity 1.0 (95% CI = 0.8-1.0), specificity 0.99 (95% CI = 0.95-1.0), positive predictive value 91% (95% CI = 69-98.4%), and negative predictive value 100% (95% CI = 97.1-100%). Discussion: In an ED setting; POC testing is accurate and correlates well with laboratory testing. Considering that the POC analysis takes a fraction of time to yield results, the validity of its data is important. The results of this study show that the POC system is a suitable test for rapid evaluation of patients presenting to the ED. This correlation increased with a higher testing positive cutoff value (0.12 versus 0.034 ng/mL). These data can assist the emergency physician with rapid identification of evidence of cardiac injury and be assured that the results are accurate. Recommendations: POC lab testing should be considered whenever possible to provide the fastest troponin results.

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“…41 Major adverse cardiac events at 30 days: death (excluding clearly noncardiac), cardiac arrest, acute myocardial infarction, emergency revascularization procedure, cardiogenic shock, ventricular arrhythmia requiring intervention, and high-degree atrioventricular block requiring intervention. †Aldous et al 42 Major adverse cardiac events at 30 days: defined as acute myocardial infarction, cardiac death, cardiogenic shock, emergency revascularization, ventricular arrhythmia or high degree heart block requiring treatment by 30 days post presentation. ‡Meller et al 43 Major adverse cardiac events at 30 days: defined as death (unless clearly noncardiac), cardiac arrest, urgent coronary revascularization, cardiogenic shock, ventricular arrhythmia needing intervention, high-degree atrioventricular block needing intervention, and acute myocardial infarction adjudicated as recommended by the Universal Definition.…”

Section: Advantages and Disadvantages Of High-sensitivity Cardiac Tromentioning

confidence: 99%

Present and Future of Cardiac Troponin in Clinical Practice: A Paradigm Shift to High-Sensitivity Assays

Sandoval

Smith

Apple

2016

The American Journal of Medicine

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Despite its wide utilization and central role in the evaluation of patients with potential ischemic symptoms, misconceptions and confusion about cardiac troponin (cTn) prevail. The implementation of high-sensitivity (hs) cTn assays in clinical practice has multiple potential advantages provided there is an education process tied to the introduction of these assays that emphasizes the appropriate utilization of the test. Several diagnostic strategies have been explored with hs-cTn assays, including the use of undetectable values, accelerated serial hs-cTn sampling, hs-cTn measurements in combination with a clinical-risk score, and the use of a single hs-cTn measurement with a concentration threshold tailored to meet a clinical need. In this document we discuss basic concepts that should facilitate the integration of hs-cTn assays into clinical care in years to come.

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Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction

Cited by 30 publications

References 28 publications

Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Comparison of Point-of-Care Versus Laboratory Troponin Testing in an Emergency Department Setting

Present and Future of Cardiac Troponin in Clinical Practice: A Paradigm Shift to High-Sensitivity Assays

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