Diagnostic Evaluation of a High-Sensitivity Troponin I Point-of-Care Assay
Key result
A 0/1 h diagnostic algorithm using a high-sensitivity troponin I point-of-care assay achieved a negative predictive value of 99.7% (95% CI 98.1-100.0%) for ruling out non-ST-elevation myocardial infarction.
Why the study?
Increasing emergency department visits for suspected myocardial infarction require faster decision-making to reduce facility burden, prompting evaluation of a point-of-care high-sensitivity troponin I assay.
Does a 0/1 h diagnostic algorithm using a high-sensitivity troponin I point-of-care assay accurately diagnose non-ST-elevation myocardial infarction in patients presenting to the emergency department with suspected myocardial infarction?
Population
Patients presenting to the emergency department with suspected myocardial infarction (669 derivation, 610 validation)
Comparison
Point-of-care high-sensitivity troponin I assay 0/1 h algorithm vs guideline-recommended laboratory-based assay
Design
Prospective cohort study
Authors
Discussion
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Member takes
Implication
Supports rapid NSTEMI rule-out with hs-TnI POC assay; leaves open generalizability pending prospective validation.
Study Design
Type
Cohort (n=1,279)
Structured PICO
Does a 0/1 h diagnostic algorithm using a high-sensitivity troponin I point-of-care assay accurately diagnose non-ST-elevation myocardial infarction in patients presenting to the emergency department with suspected myocardial infarction?
P
Population
1,279 patients presenting to the emergency department with suspected myocardial infarction (669 in derivation cohort, 610 in validation cohort).
E
Exposure
0/1 h diagnostic algorithm based on a high-sensitivity troponin I point-of-care assay (admission troponin I <4 ng/L and δ 0-1h <3 ng/L for rule out; admission troponin I ≥90 ng/L or δ 0-1h ≥20 ng/L for rule in).
C
Comparator
Guideline-recommended use of a laboratory-based high-sensitivity troponin assay.
O
Outcome
Diagnostic performance (negative predictive value for rule-out and positive predictive value for rule-in of non-ST-elevation myocardial infarction).surrogate
A point-of-care high-sensitivity troponin I assay using a 0/1 hour algorithm safely and effectively rules out or rules in NSTEMI with performance comparable to laboratory-based assays.
Cite This Study
Sörensen et al. (2019) conducted a cohort in Suspected myocardial infarction (n=1,279). High-sensitivity troponin I point-of-care assay 0/1 h algorithm vs. Laboratory-based high-sensitivity troponin assay was evaluated on Negative predictive value for rule out of non-ST-elevation myocardial infarction (95% CI 98.1-100.0). A 0/1 h diagnostic algorithm using a high-sensitivity troponin I point-of-care assay achieved a negative predictive value of 99.7% (95% CI 98.1-100.0%) for ruling out non-ST-elevation myocardial infarction.