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Short-term (90 min) diagnostic performance for acute non-ST segment elevation myocardial infarction and 30-day prognostic evaluation of a novel third-generation high sensitivity troponin I assay
- Source :
- Clinical Biochemistry. 45:1295-1301
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
Abstract
- Objectives We evaluated a third-generation high sensitivity “guidelines acceptable” troponin I assay (hs-cTnI) against a contemporary “clinically usable” troponin assay (cTnI). Design and methods Remnant samples of undifferentiated emergency department (ED) patients with suspected acute coronary syndrome were enrolled. Baseline and 90-minute samples were analyzed for cTnI and hs-cTnI. Sensitivity, specificity, positive and negative predictive values for AMI and 30-day adverse cardiac events (ACE) were compared. Results Of 486 ED patients, there were 465 patients who had blood remaining at the presentation for the hs-cTnI assays, with 12 AMIs. At presentation, the clinical sensitivity and specificity for AMI was 75% and 97% for cTnI and 83.3 and 82.1% for hs-cTnI. There were 407 patients who had paired baseline and 90-minute blood samples for cTnI and hs-cTnI including 9 of the 12 AMI patients. The sensitivity and specificity was 77.7% and 96.5% for cTnI and 100% and 81.9% for hs-cTnI at 90 min. A Δ change of 30% increase from baseline to 90 min improved the specificity to 94.5% (95% CI 92%–96%) without lowering the sensitivity. When AMI was defined as a Δ30% change of hs-cTnI at t = 0 and 90 min and one hs-cTnI result > 99th percentile cutoff, more than 3 times as many patients met the diagnostic criteria for AMI compared to results from the normal sensitive troponin assay; 28 (6.9%) for hs-cTnI vs. 9 (2.2%) with cTnI. There were 37 in-hospital or 30-day events, producing an OR of 3.03, 95% CI: 0.86–9.59 for cTnI, and 2.54, 95% CI: 1.27–5.10 for hs-cTnI, which detected 11 more cases. Conclusions The hs-cTnI assay achieved a 90-minute rule out for AMI and detected more 3 times as many AMI cases. The specificity increased with the Δ30% criteria. The hs-cTnI assay also detected more cases of patient at risk for adverse cardiac events at 30 days.
- Subjects :
- Adult
Male
medicine.medical_specialty
Acute coronary syndrome
Clinical Biochemistry
Myocardial Infarction
macromolecular substances
Young Adult
Internal medicine
Positive predicative value
Troponin I
medicine
Humans
ST segment
cardiovascular diseases
Myocardial infarction
Aged
Aged, 80 and over
biology
business.industry
General Medicine
Emergency department
Middle Aged
Prognosis
musculoskeletal system
medicine.disease
Troponin
ROC Curve
Area Under Curve
cardiovascular system
Cardiology
biology.protein
Female
Myocardial infarction diagnosis
business
Blood Chemical Analysis
Subjects
Details
- ISSN :
- 00099120
- Volume :
- 45
- Database :
- OpenAIRE
- Journal :
- Clinical Biochemistry
- Accession number :
- edsair.doi.dedup.....3586e9caf00866e7b1ea54317590c2cc