Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I

Sandoval, Yader; Nowak, Richard M.; deFilippi, Christopher R.; Christenson, Robert H.; Peacock, W. Frank; McCord, James; Sexter, Anne; Apple, Fred S.

doi:10.1016/j.jacc.2019.05.058

Cited by 80 publications

(50 citation statements)

References 22 publications

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“…We used receiver operating characteristic (ROC) curve analysis to evaluate global diagnostic accuracy and calculated the area under the curve using the method described by De Long et al [18]. We also sought to determine diagnostic accuracy at a cut-off of 5ng/L, which has recently been reported in the literature as the 'HighSTEACS' cut-off [19] and subsequently validated in a patient cohort from the United States [20]. Finally, we evaluated diagnostic accuracy at the 'rulein' cut-off of 120ng/L, which was also reported in both previous studies.…”

Section: Discussionmentioning

confidence: 99%

Single test rule-out of acute myocardial infarction using the limit of detection of a new high-sensitivity troponin I assay

Body

Morris

Collinson³

2020

Clinical Biochemistry

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Section: Discussionmentioning

confidence: 99%

Single test rule-out of acute myocardial infarction using the limit of detection of a new high-sensitivity troponin I assay

Body

Morris

Collinson³

2020

Clinical Biochemistry

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“… 1 , 2 , 3 These findings were generated with an Abbott Laboratories (Abbott Park, IL) hs-cTnI assay, and recent publications demonstrating a 5 ng/L cutoff might be suitable for one of Siemens Healthcare Diagnostics (Munich, Germany) hs-cTnI assays, suggesting an overall low concentration cutoff of 5 ng/L may be applicable to more than 1 hs-cTnI assay. 4 , 5 Accordingly, this leads to the concept of a single rule-out cutoff when using hs-cTnI assays, which has been published by the European Society of Cardiology guidelines 6 and most recently discussed in the Fourth Universal Definition of MI, which provided the following balanced statement: “Some studies indicate that the single sample approach provides optimal sensitivity and negative predictive accuracy in patients otherwise at low risk and those with a normal electrocardiogram. However, one concern about short rule-out periods is that the precision of the assays may not permit small differences to be distinguished.” 7…”

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confidence: 99%

High-Sensitivity Cardiac Troponin I vs a Clinical Chemistry Score for Predicting All-Cause Mortality in an Emergency Department Population

Kavsak

Cerasuolo

et al. 2020

CJC Open

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Background For patients investigated for suspected acute coronary syndrome, there is uncertainty if a single measurement of high-sensitivity cardiac troponin I (hs-cTnI) at emergency department (ED) presentation can identify patients at both low and high risk for mortality. Methods We included consecutive adult patients in the ED who had a Clinical Chemistry Score (CCS) taken at presentation (ie, combination of glucose, creatinine for estimated glomerular filtration rate determination, and hs-cTnI assay) in a Canadian city between 2012 and 2013. Outcomes were 3-month, 1-year, and 5-year all-cause mortality using the provincial death registry. Mortality rates and test performance (eg, sensitivity and specificity) with 95% confidence intervals (CIs) were obtained for the CCS or hs-cTnI assay alone using established cutoffs for these tests. Results Our cohort included 5974 patients with a 1-year mortality rate of 17.2% (95% CI, 16.2-18.3). A CCS ≥ 1 yielded a sensitivity of 99.2% (95% CI, 98.4-99.6) compared with the hs-cTnI ≥ 5 ng/L cutoff sensitivity of 88.4% (95% CI, 86.3-90.3), with the mortality rate being significantly lower for patients with CCS < 1 (2.0%; 95% CI, 0.9-4.0) vs patients with hs-cTnI < 5 ng/L (5.0%; 95% CI, 4.2-6.0) at 1 year ( P = 0.01). A CCS of 5 also yielded a higher specificity (88.5%; 95% CI, 87.5-89.3) compared with hs-cTnI > 26 ng/L (83.9%; 95% CI, 82.9-84.9), with no difference in mortality rates (37.4% vs 36.3%; P = 0.66). This trend was consistent at 3-month and 5-year mortality. Conclusion For patients in the ED with a potential cardiac issue, using the CCS cutoffs can better identify patients at low and high risk for mortality than using published cutoffs for hs-cTnI alone.

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“…Several individual studies and a number of large metaanalyses have shown that in patients without high-risk features, a single test of cardiac troponin using a highly sensitive troponin assay can identify patients at a very low risk of death, AMI, or other major adverse cardiac events, at 30 days with very high sensitivity and negative predictive value (Table 1) [5][6][7][8].…”

Section: Earlier Identification: Single Troponin Testing On Presentationmentioning

confidence: 99%

CSANZ Position Statement on the Evaluation of Patients Presenting With Suspected Acute Coronary Syndromes During the COVID-19 Pandemic

Parsonage

Cullen

Brieger

et al. 2020

Heart, Lung and Circulation

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A pandemic of Coronavirus-19 disease was declared by the World Health Organization on March 11, 2020. The pandemic is expected to place unprecedented demand on health service delivery. This position statement has been developed by the Cardiac Society of Australia and New Zealand to assist clinicians to continue to deliver rapid and safe evaluation of patients presenting with suspected acute cardiac syndrome at this time. The position statement complements, and should be read in conjunction with, the National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016: Section 2 'Assessment of Possible Cardiac Chest Pain'.

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Myocardial Infarction Risk Stratification With a Single Measurement of High-Sensitivity Troponin I

Cited by 80 publications

References 22 publications

Single test rule-out of acute myocardial infarction using the limit of detection of a new high-sensitivity troponin I assay

Single test rule-out of acute myocardial infarction using the limit of detection of a new high-sensitivity troponin I assay

High-Sensitivity Cardiac Troponin I vs a Clinical Chemistry Score for Predicting All-Cause Mortality in an Emergency Department Population

CSANZ Position Statement on the Evaluation of Patients Presenting With Suspected Acute Coronary Syndromes During the COVID-19 Pandemic

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