August 13, 2021Journal of Cardiovascular Development and DiseaseOpen Access

Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected Acute Coronary Syndrome (n=3901). Intervention: Serial high-sensitivity cardiac troponin I (hsTnI) algorithms (COMPASS-MI, ESC 0/2h, High-STEACS) vs. Diagnostic benchmarks (sensitivity ≥ 99.0%, specificity ≥ 90.0%). Primary outcome: 30-day myocardial infarction or all-cause death (Sensitivity of COMPASS-MI algorithm in Cohort-2) (Sensitivity 98.6%, 95% CI 95.1-99.8).

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Key result

Serial high-sensitivity cardiac troponin I testing using the COMPASS-MI algorithm achieved a maximum sensitivity of 98.6% for 30-day myocardial infarction or death, failing to meet the ≥99.0% benchmark required for safely ruling out patients.

Why the study?

Three major algorithms exist for serial hsTnI testing, but comparative diagnostic estimates and whether one is superior across different ED populations remained unknown.

Does serial high-sensitivity cardiac troponin I testing using ESC, High-STEACS, or COMPASS-MI algorithms improve diagnostic accuracy for 30-day MI or death in ED patients?

Population

2966 undifferentiated ED patients (Cohort-1) and 935 ED patients with suspected ACS (Cohort-2)

Comparison

ESC vs High-STEACS vs COMPASS-MI serial hsTnI algorithms

Design

Blinded prospective cohort study

Follow-up

30 days

Authors

PKPeter A. KavsakGeneral Cardiology MHMark HewittUniversity of Sudbury SMShawn MondouxUniversity of Toronto

Discussion

Member takes

Implication

None of the three major hsTnI algorithms (ESC, High-STEACS, COMPASS-MI) achieved the proposed sensitivity benchmark of ≥99% for 30-day MI or death in ED patients.

Study Design

Type

Observational (n=3,901)

Blinding

Physicians blinded to hsTnI results

Multicenter

Yes

Structured PICO

Does serial high-sensitivity cardiac troponin I testing using ESC, High-STEACS, or COMPASS-MI algorithms improve diagnostic accuracy for 30-day MI or death in ED patients?

Population

3,901 emergency department patients (2,966 undifferentiated and 935 with symptoms suggestive of acute coronary syndrome) who had serial high-sensitivity cardiac troponin I measurements, evaluated for 30-day myocardial infarction or death.

Exposure

Serial high-sensitivity cardiac troponin I (hsTnI) testing evaluated using three algorithms: European Society of Cardiology (ESC), High-STEACS pathway, and COMPASS-MI algorithm.

Comparator

Proposed diagnostic benchmarks (sensitivity ≥ 99.0% and specificity ≥ 90.0%).

Outcome

30-day MI or death.composite

Main Result

Effect estimate: Sensitivity 98.6% (95% CI 95.1-99.8)

None of the three major hsTnI algorithms (ESC, High-STEACS, COMPASS-MI) achieved the proposed sensitivity benchmark of ≥99% for 30-day MI or death in ED patients.

Limitations

Serial sampling occurred later than 2 hours after presentation
Findings are from a single urban city
Outcomes were assessed differently between cohorts (adjudication versus administrative databases)
Different lower limits of reporting for hsTnI were utilized between the two cohorts

Cite This Study

Kavsak et al. (2021) conducted an observational in Suspected Acute Coronary Syndrome (n=3,901). Serial high-sensitivity cardiac troponin I (hsTnI) algorithms (COMPASS-MI, ESC 0/2h, High-STEACS) vs. Diagnostic benchmarks (sensitivity ≥ 99.0%, specificity ≥ 90.0%) was evaluated on 30-day myocardial infarction or all-cause death (Sensitivity of COMPASS-MI algorithm in Cohort-2) (Sensitivity 98.6%, 95% CI 95.1-99.8). Serial high-sensitivity cardiac troponin I testing using the COMPASS-MI algorithm achieved a maximum sensitivity of 98.6% for 30-day myocardial infarction or death, failing to meet the ≥99.0% benchmark required for safely ruling out patients.

synapsesocial.com/papers/6aa2f4646401f02f7be57584 https://doi.org/10.3390/jcdd8080097

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Implication

None of the three major hsTnI algorithms (ESC, High-STEACS, COMPASS-MI) achieved the proposed sensitivity benchmark of ≥99% for 30-day MI or death in ED patients.

Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider