October 31, 2022Circulation84 citationsOpen Access
Single High-Sensitivity Point-of-Care Whole-Blood Cardiac Troponin I Measurement to Rule Out Acute Myocardial Infarction at Low Risk
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Structured PICO
Does a point-of-care whole-blood high-sensitivity cardiac troponin I assay accurately rule out myocardial infarction at 30 days in patients presenting to the emergency department with suspected acute coronary syndrome?
P
Population
2,572 consecutive patients presenting to the emergency department with suspected acute coronary syndrome (1,086 in US derivation cohort, 1,486 in Australian validation cohort)
I
Intervention
Point-of-care (POC) whole-blood high-sensitivity cardiac troponin I (hs-cTnI) assay (Atellica VTLi) at presentation with a threshold of <4 ng/L
C
Comparator
Routine clinical care high-sensitivity cardiac troponin I (hs-cTnI) assay results (used as reference standard for event adjudication)
O
Outcome
Myocardial infarction (MI) at 30 dayshard clinical
A point-of-care whole-blood high-sensitivity troponin I assay with a threshold of <4 ng/L safely and rapidly rules out myocardial infarction in patients presenting to the emergency department with suspected acute coronary syndrome.
Abstract
BACKGROUND: High-sensitivity cardiac troponin (hs-cTn) laboratory assays are used to rule out myocardial infarction (MI) on presentation, but prolonged result turnaround times can delay patient management. Our primary aim was to identify patients at low risk of index MI using a rapid point-of-care (POC) whole-blood hs-cTnI assay at presentation with potential early patient discharge. METHODS: Consecutive patients presenting to the emergency department from 2 prospective observational studies with suspected acute coronary syndrome were enrolled. A POC hs-cTnI assay (Atellica VTLi) threshold using whole blood at presentation, which resulted in a negative predictive value of ≥99. 5% and sensitivity of >99% for index MI, was derived (SEIGE Safe Emergency Department Discharge Rate) and validated with plasma (SAMIE Suspected Acute Myocardial Infarction in Emergency). Event adjudications were established with hs-cTnI assay results from routine clinical care. The primary outcome was MI at 30 days. RESULTS: A total of 1086 patients (8. 1% with MI) were enrolled in a US derivation cohort (SEIGE) and 1486 (5. 5% MI) in an Australian validation cohort (SAMIE). A derivation whole-blood POC hs-cTnI concentration of <4 ng/L provided a sensitivity of 98. 9% (95% CI, 93. 8%-100%) and negative predictive value of 99. 5% (95% CI, 97. 2%-100%) for ruling out MI. In the validation cohort, the sensitivity was 98. 8% (95% CI, 93. 3%-100%), and negative predictive value was 99. 8% (95% CI, 99. 1%-100%) ; 17. 8% and 41. 8%, respectively, were defined as low risk for discharge. The 30-day adverse cardiac events were 0. 1% (n=1) for SEIGE and 0. 8% (n=5) for SAMIE. CONCLUSIONS: A POC whole-blood hs-cTnI assay permits accessible, rapid, and safe exclusion of MI and may expedite discharge from the emergency department. REGISTRATION: URL: https: //www. CLINICALTRIALS: gov; Unique identifier: NCT04772157. URL: https: //www. australianclinicaltrials. gov. au/anzctrfeed/form; Unique identifier: 12621000053820.
Cite This Study
Apple et al. (2022) studied this question.