Analytical Concordance of Diverse Point-of-Care and Central Laboratory Troponin I Assays
Key result
Using a fixed cutoff of 0.03 to 0.05 ng/mL increased the concordance between point-of-care contemporary and high-sensitivity troponin I assays from 80-90% to 90-95%.
Why the study?
Do contemporary point-of-care and central laboratory troponin I assays show analytical concordance with high-sensitivity troponin I assays in coronary care unit inpatients?
Population
102 inpatients in the coronary care unit
Comparison
3 point-of-care and 1 central laboratory… vs Abbott high-sensitivity (hs) cTnI assay
Design
Cross-sectional
Authors
Discussion
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Implication
Uniform troponin cutoff may enhance POC-hs-cTnI concordance in CCU inpatients; hypothesis-generating for outcomes, needs prospective validation.
Key Points
- The aim is to evaluate the analytical concordance of various troponin I assays to determine if a single cutoff is feasible.
- Measured cTnI levels in blood samples from 102 inpatients using both point-of-care and central laboratory assays.
- Analyzed agreement between assays through regression analysis and assessed proportional bias using Bland-Altman plots.
- Determined concordance at specific cutoffs using diagnostic contingency tables.
- Overall concordance between POC assays and hs-cTnI was 80% to 90% at their respective 99th percentile cutoffs.
- Concordance improved to 90% to 95% with a fixed cutoff of 0.03 to 0.05 ng/mL across all assays.
- Proportional bias was evident across all cTnI assays, indicating analytical discrepancies.
Study Design
Type
Cross-Sectional (n=102)
Structured PICO
Do contemporary point-of-care and central laboratory troponin I assays show analytical concordance with high-sensitivity troponin I assays in coronary care unit inpatients?
P
Population
102 inpatients in the coronary care unit evaluated for analytical concordance across diverse point-of-care and central laboratory troponin I assays.
E
Exposure
3 point-of-care (POC) and 1 central laboratory contemporary cTnI assays (Alere Triage Troponin I, Radiometer AQT90, Abbott i-STAT, Beckman Coulter DxI AccuTnI+3 TnI)
C
Comparator
Abbott high-sensitivity (hs) cTnI assay
O
Outcome
Analytical concordance and proportional bias between contemporary cTnI assays and hs-cTnI assaysurrogate
A single clinical decision limit for troponin I (0.03-0.05 ng/mL) improves diagnostic concordance across diverse assays compared to assay-specific 99th percentile cutoffs.
Cite This Study
Tsui et al. (2018) conducted a cross-sectional in Inpatients in the coronary care unit (n=102). Point-of-care and central laboratory contemporary cTnI assays vs. Abbott high-sensitivity (hs) cTnI assay was evaluated on Analytical concordance between contemporary cTnI assays and hs-cTnI assay. Using a fixed cutoff of 0.03 to 0.05 ng/mL increased the concordance between point-of-care contemporary and high-sensitivity troponin I assays from 80-90% to 90-95%.