Diagnostic Performance of High Sensitivity Compared with Contemporary Cardiac Troponin I for the Diagnosis of Acute Myocardial Infarction
Key result
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.
Why the study?
Does high-sensitivity cardiac troponin I improve the diagnostic performance for acute myocardial infarction compared to contemporary cardiac troponin I in emergency department patients?
Population
1631 consecutive patients presenting to a US emergency department with serial cTnI on clinical indication
Comparison
High-sensitivity cardiac troponin I assay using… vs Contemporary cardiac troponin I (cTnI) assay
Design
Cohort
Follow-up
30-day
Authors
Discussion
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Member takes
Implication
hs-cTnI with normal ECG may aid MI rule-out; leaves open optimal deltas for rule-in versus contemporary assays in ED practice.
Study Design
Type
Observational (n=1,631)
Multicenter
No
Structured PICO
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
Population
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
Exposure
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
Comparator
Contemporary cardiac troponin I (cTnI) assay
O
Outcome
Diagnostic performance for acute MI, including MI subtypes, and 30-day outcomessurrogate
Main Result
Absolute Event Rate: 100% vs 99.5%
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.
Cite This Study
Sandoval et al. (2017) conducted an observational in Acute myocardial infarction (n=1,631). High-sensitivity cardiac troponin I (hs-cTnI) vs. Contemporary cardiac troponin I (cTnI) was evaluated on Negative predictive value for ruling out acute MI using ≤99th percentile and a normal ECG. 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.