Key result
Point-of-care troponin I assay demonstrated 95% sensitivity and 100% specificity at 3 hours post-admission, comparable to laboratory high-sensitivity troponin T for evaluating chest pain.
Why the study?
Diagnosing acute coronary syndrome in emergency department patients with chest pain is challenging, prompting a comparison of point-of-care troponin I with laboratory HsTnT.
Does point-of-care troponin I have comparable diagnostic performance to laboratory high-sensitivity troponin T in adult patients presenting to the emergency department with chest pain?
Observational (n=303)
No
Does point-of-care troponin I have comparable diagnostic performance to laboratory high-sensitivity troponin T in adult patients presenting to the emergency department with chest pain?
Point-of-care troponin I at 3 hours post-admission has comparable diagnostic performance to laboratory high-sensitivity troponin T for ruling out NSTEMI in emergency department patients with chest pain.
Answers are grounded in this paper and cite their sources.
May support 3-hour POC troponin I for ED chest pain evaluation; leaves open need for prospective validation before practice change.
BACKGROUND: Chest pain is a common symptom in patients visiting the emergency department (ED). Diagnosing acute coronary syndrome is a challenging task for emergency physicians. Evaluation of chest pain depends on clinical symptoms and signs, ECG, and cardiac enzymes. Here, we aimed to compare the diagnostic performance of the point-of-care troponin I assay with laboratory HsTnT assay in patients presenting to the ED with chest pain. METHODS: A prospective study was done at the ED of Alkhor Hospital, Hamad Medical Corporation, between March 2016 and December 2016. Patients more than 18 years old who presented to the ED with chest pain were enrolled. Patients with renal failure, initial ECG showing ST-elevation MI, or arrhythmias, and hemodynamically unstable patients were excluded. A blood sample was collected at 0 and 3 hours post-admission for POC TnI and laboratory HsTnT assay. The sensitivity, specificity, PPV, NPV, and AUC were determined and compared. RESULTS: Out of 313 patients enrolled, ten were excluded. At 0 hour, the POC TnI assay had a lower sensitivity (72.5% versus 97.5%) and had almost equal specificity (99.24% versus 93.2%) when compared to lab HsTnT assay. At 3 hours post-admission, the sensitivity increased to 95% versus 100%, and specificity was 100% versus 94.3% when compared to lab HsTnT. The POC TnI assay had a higher PPV than HsTnT, whereas both assays showed a high NPV at 0 and 3 hours. CONCLUSION: Although the diagnostic performance of POC TnI was lower than that of Lab HsTnT at 0 hour, at 3 hours post-admission, the diagnostic performance was almost equal to that of HsTnT. Hence we conclude that chest pain in patients with a negative POC TnI at 3 hours post-admission is unlikely to be due to NSTEMI.
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Mohammad et al. (2020) conducted an observational in Chest pain (n=303). Point-of-care troponin I (POC TnI) assay vs. Laboratory high-sensitivity troponin T (HsTnT) assay was evaluated on Sensitivity at 3 hours post-admission. Point-of-care troponin I assay demonstrated 95% sensitivity and 100% specificity at 3 hours post-admission, comparable to laboratory high-sensitivity troponin T for evaluating chest pain.
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