Diagnostic and prognostic utility of early measurement with high-sensitivity troponin T assay in patients presenting with chest pain
Key result
The high-sensitivity troponin T assay at the 99th percentile cut-off demonstrated a sensitivity of 92.2% for diagnosing non-ST-segment myocardial infarction by two hours after presentation.
Why the study?
Does early measurement with high-sensitivity troponin T assay improve diagnosis and prognostic utility compared to conventional assays in patients presenting with chest pain?
Population
Patients presenting with chest pain
Comparison
Early measurement with high-sensitivity troponin… vs Conventional troponin assays
Design
Review
Authors
Discussion
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Implication
May support 2-hour hs-TnT testing for NSTEMI; leaves open whether outcomes improve versus conventional assays.
Key Points
- To evaluate the diagnostic and prognostic performance of early measurement with high-sensitivity troponin T assays in patients presenting with acute chest pain.
- Evaluated high-sensitivity cardiac troponin assays developed to meet diagnostic guidelines for acute myocardial infarction.
- Assessed early detection capacity for myocardial injury and risk stratification utility compared to conventional troponin assays.
- High-sensitivity assays detect myocardial injury substantially earlier following acute symptom onset than conventional assays.
- Enhanced clinical sensitivity identifies a greater number of patients at elevated risk for subsequent adverse cardiovascular outcomes.
Study Design
Type
Observational (n=939)
Blinding
Single-blind
Multicenter
Yes
Structured PICO
Does early measurement with high-sensitivity troponin T assay improve diagnosis and prognostic utility compared to conventional assays in patients presenting with chest pain?
P
Population
Patients presenting with chest pain
I
Intervention
Early measurement with high-sensitivity troponin T assay
C
Comparator
Conventional troponin assays
O
Outcome
Diagnosis of acute myocardial infarction and identification of patients at risk of future adverse outcomes
High-sensitivity troponin T assays provide earlier detection of myocardial injury and better prognostic information than conventional assays in patients with chest pain.
Limitations
- The incidence of non-ST-segment elevation myocardial infarction in the study population may be higher than that seen elsewhere.
- Blood samples for the high-sensitivity troponin T assay were taken only at presentation and two hours later, lacking later comparative samples.
- The conventional troponin I assay is an imperfect gold standard for the assessment of another troponin assay.
Cite This Study
Aldous et al. (2012) conducted an observational in Chest pain without ST-segment elevation (n=939). High-sensitivity troponin T assay vs. Conventional troponin I assay was evaluated on Diagnosis of non-ST-segment elevation myocardial infarction on admission (95% CI 88.1%-95.0%). The high-sensitivity troponin T assay at the 99th percentile cut-off demonstrated a sensitivity of 92.2% for diagnosing non-ST-segment myocardial infarction by two hours after presentation.