July 12, 2017Open Access
Ver artículo completoDiagnostic Performance of High Sensitivity Compared with Contemporary Cardiac Troponin I for the Diagnosis of Acute Myocardial Infarction
Resultado clave
High-sensitivity cardiac troponin I yielded a 100% negative predictive value for ruling out acute MI at 0 and 3 hours, compared to 99.5% for contemporary troponin I at 0, 3, and 6 hours.
Diseño del estudio
Tipo
Observational (n=1,631)
Multicéntrico
No
PICO estructurado
Does high-sensitivity cardiac troponin I improve the diagnostic performance for acute myocardial infarction compared to contemporary cardiac troponin I in emergency department patients?
P
Población
1,631 consecutive patients presenting to a US emergency department with clinical indication for serial troponin testing, evaluated for acute myocardial infarction and 30-day outcomes.
E
Exposición
High-sensitivity cardiac troponin I (hs-cTnI) assay using the 99th percentile alone and with a normal ECG to rule out MI, and serial changes (deltas) to rule in MI
C
Comparador
Contemporary cardiac troponin I (cTnI) assay
O
Resultado
Diagnostic performance for acute MI, including MI subtypes, and 30-day outcomessurrogate
High-sensitivity cTnI at 0 and 3 hours combined with a normal ECG provides 100% sensitivity and negative predictive value for ruling out acute MI, performing excellently alongside contemporary assays.
Resultado numérico
Tasa de eventos absoluta: 100% vs 99.5%
Resumen
BACKGROUND: We examined the diagnostic performance of high-sensitivity cardiac troponin I (hs-cTnI) vs contemporary cTnI with use of the 99th percentile alone and with a normal electrocardiogram (ECG) to rule out acute myocardial infarction (MI) and serial changes (deltas) to rule in MI. METHODS: We included consecutive patients presenting to a US emergency department with serial cTnI onclinical indication. Diagnostic performance for acute MI, including MI subtypes, and 30-day outcomes were examined. RESULTS: Among 1631 patients, MI was diagnosed in 12.9% using the contemporary cTnI assay and in 10.4% using the hs-cTnI assay. For ruling out MI, contemporary cTnI ≤99th percentile at 0, 3, and 6 h and a normal ECG had a negative predictive value (NPV) of 99.5% (95% CI, 98.6-100) and a sensitivity of 99.1% (95% CI, 97.4-100) for diagnostic and safety outcomes. Serial hs-cTnI measurements ≤99th percentile at 0 and 3 h and a normal ECG had an NPV and sensitivity of 100% (95% CI, 100-100) for diagnostic and safety outcomes. For ruling in MI, contemporary cTnI measurements had specificities of 84.4% (95% CI, 82.5-86.3) at presentation and 78.7% (95% CI, 75.4-82.0) with serial testing at 0, 3, and 6 h, improving to 89.2% (95% CI, 87.1-91.3) by using serial cTnI changes (delta, 0 and 6 h) >150%. hs-cTnI had specificities of 86.9% (95% CI, 85.1-88.6) at presentation and 85.7% (95% CI, 83.5-87.9) with serial testing at 0 and 3 h, improving to 89.3% (95% CI, 87.3-91.2) using a delta hs-cTnI (0 and 3 h) >5 ng/L. CONCLUSIONS: hs-cTnI and contemporary cTnI assays are excellent in ruling out MI following recommendations predicated on serial testing and the 99th percentile with a normal ECG. For ruling in MI, deltas improve the specificity. ClinicalTrials.gov Identifier: NCT02060760.