Key result
Fast and six-hour highly sensitive troponin T protocols provided similar diagnostic accuracy for acute coronary syndrome, both demonstrating a sensitivity of 0.89.
Why the study?
What is the diagnostic accuracy of various functional, imaging, and biochemical tests for detecting acute coronary syndrome in patients presenting with chest pain to the emergency department?
Meta-Analysis (n=49,541)
What is the diagnostic accuracy of various functional, imaging, and biochemical tests for detecting acute coronary syndrome in patients presenting with chest pain to the emergency department?
Absolute Event Rate: 0.89% vs 0.89%
Fast and six-hour hs-TnT protocols offer similar diagnostic accuracy for ACS, and CCTA provides the highest diagnostic accuracy among non-invasive tests for patients without troponin elevation.
Fast hs-TnT protocols match six-hour accuracy for ACS; supports expedited ED workflows in meta-analytic evidence.
Background: Non-invasive ischaemia tests and biomarkers are widely adopted to rule out acute coronary syndrome in the emergency department. Their diagnostic accuracy has yet to be precisely defined. Methods: Medline, Cochrane Library CENTRAL, EMBASE and Biomed Central were systematically screened (start date 1 September 2016, end date 1 December 2016). Prospective studies (observational or randomised controlled trial) comparing functional/imaging or biochemical tests for patients presenting with chest pain to the emergency department were included. Results: Overall, 77 studies were included, for a total of 49,541 patients (mean age 59.9 years). Fast and six-hour highly sensitive troponin T protocols did not show significant differences in their ability to detect acute coronary syndromes, as they reported a sensitivity and specificity of 0.89 (95% confidence interval 0.79–0.94) and 0.84 (0.74–0.9) vs 0.89 (0.78–0.94) and 0.83 (0.70–0.92), respectively. The addition of copeptin to troponin increased sensitivity and reduced specificity, without improving diagnostic accuracy. The diagnostic value of non-invasive tests for patients without troponin increase was tested. Coronary computed tomography showed the highest level of diagnostic accuracy (sensitivity 0.93 (0.81–0.98) and specificity 0.90 (0.93–0.94)), along with myocardial perfusion scintigraphy (sensitivity 0.85 (0.77–0.91) and specificity 0.92 (0.83–0.96)). Stress echography was inferior to coronary computed tomography but non-inferior to myocardial perfusion scintigraphy, while exercise testing showed the lower level of diagnostic accuracy. Conclusions: Fast and six-hour highly sensitive troponin T protocols provide an overall similar level of diagnostic accuracy to detect acute coronary syndrome. Among the non-invasive ischaemia tests for patients without troponin increase, coronary computed tomography and myocardial perfusion scintigraphy showed the highest sensitivity and specificity.
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Iannaccone et al. (2018) conducted a meta-analysis in Chest pain / Acute coronary syndrome (n=49,541). Fast highly sensitive troponin T protocols vs. Six-hour highly sensitive troponin T protocols was evaluated on Sensitivity for detecting acute coronary syndromes (95% CI 0.79-0.94). Fast and six-hour highly sensitive troponin T protocols provided similar diagnostic accuracy for acute coronary syndrome, both demonstrating a sensitivity of 0.89.
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