What question did this study set out to answer?

To compare the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and troponin I (hs-cTnI) assays at 90 minutes versus 3 hours for predicting hospitalization for acute coronary syndrome (ACS).

July 11, 2013Clinical ChemistryOpen Access

Ninety-Minute vs 3-h Performance of High-Sensitivity Cardiac Troponin Assays for Predicting Hospitalization for Acute Coronary Syndrome

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Why the study?

Does high-sensitivity cardiac troponin measurement at 90 minutes match or improve the diagnostic performance of 3-hour measurements for predicting ACS hospitalization in patients presenting to the ED with chest pain?

Population

130 adult patients presenting to the emergency department within 6 h of chest pain onset with suspected ACS…

Comparison

High-sensitivity cardiac troponin T and I… vs High-sensitivity cardiac troponin T and I…

Design

Cohort, Outcome adjudicators were blinded to the hs-cTnT and hs-cTnI results

Follow-up

72 h

Authors

PKPeter A. KavsakGeneral Cardiology AWAndrew WorsterCardiac Imaging JYJohn J. YouTrillium Health Centre

Discussion

Member takes

Implication

May favor 3-hour hs-cTn sampling for ACS discrimination in ED chest pain; leaves open prospective validation before protocol changes.

Key Points

To compare the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and troponin I (hs-cTnI) assays at 90 minutes versus 3 hours for predicting hospitalization for acute coronary syndrome (ACS).
Prospective cohort analysis of 130 adult emergency department patients presenting within 6 hours of chest pain onset with plasma samples collected at baseline, 90 minutes, and 3 hours.
Blinded adjudication of ACS hospitalization (acute myocardial infarction, unstable angina, or refractory ischemic pain) over a 72-hour follow-up window.
Discriminative performance evaluated via receiver operating characteristic (ROC) curves and area under the curve (AUC) comparisons using the DeLong method.
Hospitalization for ACS occurred in 14 of 130 patients (10.8%), including 8 cases of acute myocardial infarction and 6 cases of unstable angina or refractory ischemic cardiac pain.
Discriminative accuracy was statistically superior at 3 hours compared to 90 minutes for hs-cTnT (AUC 0.81 [95% CI, 0.65–0.97] vs 0.80 [95% CI, 0.64–0.95]; P < 0.01) and hs-cTnI (AUC 0.83 [95% CI, 0.68–0.97] vs 0.81 [95% CI, 0.66–0.96]; P < 0.01).
Troponin concentrations in the ACS group showed no significant change from baseline to 90 minutes (hs-cTnT P = 0.11; hs-cTnI P = 0.05), but rose significantly by 3 hours compared to baseline (both P < 0.01).

Structured PICO

Population

130 adult patients (≥18 years old) presenting to the emergency department within 6 h of chest pain onset with suspected ACS. Median age 60, 64% male. Excluded patients with ST-elevation myocardial infarction, trauma, direct referral to surgery, and previously enrolled individuals.

Intervention

High-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) measurements at 90 minutes post-presentation

Comparator

High-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI) measurements at 3 hours post-presentation

Outcome

Hospitalization for acute coronary syndrome (ACS) at 72 hours (combined outcome of AMI or hospitalization for unstable angina or refractory ischemic cardiac pain)composite

High-sensitivity cardiac troponin measurements at 3 hours provide superior diagnostic discrimination for acute coronary syndrome compared to 90-minute measurements in emergency department patients with chest pain.

Limitations

Small sample size requiring larger prospective studies for validation

Cite This Study

Kavsak et al. (2013) studied this question.

synapsesocial.com/papers/6a83d16c8df3fed3c85bd734 https://doi.org/10.1373/clinchem.2013.208595

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Ninety-Minute vs 3-h Performance of High-Sensitivity Cardiac Troponin Assays for Predicting Hospitalization for Acute Coronary Syndrome

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Ninety-Minute vs 3-h Performance of High-Sensitivity Cardiac Troponin Assays for Predicting Hospitalization for Acute Coronary Syndrome

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider