Key result
A high-sensitivity troponin T limit of detection cutoff (<5 ng/L) at ED presentation yielded 97.9% sensitivity for 30-day major cardiovascular events, but rounding reduced early discharge eligibility from 28.4% to 22.8%.
Why the study?
Several issues remain unexplored regarding rule-out strategies using low concentrations of high-sensitivity cardiac troponin assays at ED presentation, including cutoff concentrations for hs-cTnI, applicability to hs-cTnT, and the impact of laboratory rounding on diagnostic performance and early discharge eligibility.
Cohort (n=922)
No
Answers are grounded in this paper and cite their sources.
To the Editor: Several issues around rule-out strategies utilizing low concentrations of high-sensitivity cardiac troponin assays taken at presentation to the Emergency Department (ED)1 remain unexplored. First, large-scale analyses investigating cutoff concentrations for high-sensitivity cardiac troponin I (hs-cTnI; Abbott Architect) <99th percentile, have failed to investigate outcomes that incorporate the full spectrum of clinically relevant acute coronary syndromes, namely emergency revascularization (1, 2). Second, whether these strategies work with the high-sensitivity cardiac troponin T (hs-cTnT; Roche Elecsys) assay is underexplored. Finally, the impact of laboratory rounding (i.e., rounding the reported value up or down to the next whole integer depending on the exact post–decimal point value—e.g., 4.5 ng/L to 5 ng/L) upon diagnostic performance at low cutoff concentrations, and how this effects the proportion of patients potentially eligible for early discharge, remains unknown.
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Carlton et al. (2016) conducted a cohort in Chest pain suggestive of cardiac ischemia (n=922). High-sensitivity cardiac troponin T (hs-cTnT) at presentation (<5 ng/L limit of detection) vs. Unrounded laboratory values was evaluated on Sensitivity for Major Adverse Cardiac Events (MACE) within 30 days using a rounded LoD cut-off (Sensitivity 97.9%, 95% CI 92.0-99.6). A high-sensitivity troponin T limit of detection cutoff (<5 ng/L) at ED presentation yielded 97.9% sensitivity for 30-day major cardiovascular events, but rounding reduced early discharge eligibility from 28.4% to 22.8%.
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