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

Serial high-sensitivity cardiac troponin (hsTn) testing in the emergency department (ED) and the intensive cardiac care unit may assist physicians in ruling out or ruling in acute myocardial infarction (MI). There are three major algorithms proposed for high-sensitivity cardiac troponin I (hsTnI) us...

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Autores principales: Kavsak, Peter A., Hewitt, Mark K., Mondoux, Shawn E., Cerasuolo, Joshua O., Ma, Jinhui, Clayton, Natasha, McQueen, Matthew, Griffith, Lauren E., Perez, Richard, Seow, Hsien, Ainsworth, Craig, Ko, Dennis T., Worster, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397128/
https://www.ncbi.nlm.nih.gov/pubmed/34436239
http://dx.doi.org/10.3390/jcdd8080097
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author Kavsak, Peter A.
Hewitt, Mark K.
Mondoux, Shawn E.
Cerasuolo, Joshua O.
Ma, Jinhui
Clayton, Natasha
McQueen, Matthew
Griffith, Lauren E.
Perez, Richard
Seow, Hsien
Ainsworth, Craig
Ko, Dennis T.
Worster, Andrew
author_facet Kavsak, Peter A.
Hewitt, Mark K.
Mondoux, Shawn E.
Cerasuolo, Joshua O.
Ma, Jinhui
Clayton, Natasha
McQueen, Matthew
Griffith, Lauren E.
Perez, Richard
Seow, Hsien
Ainsworth, Craig
Ko, Dennis T.
Worster, Andrew
author_sort Kavsak, Peter A.
collection PubMed
description Serial high-sensitivity cardiac troponin (hsTn) testing in the emergency department (ED) and the intensive cardiac care unit may assist physicians in ruling out or ruling in acute myocardial infarction (MI). There are three major algorithms proposed for high-sensitivity cardiac troponin I (hsTnI) using serial measurements while incorporating absolute concentration changes for MI or death following ED presentation. We sought to determine the diagnostic estimates of these three algorithms and if one was superior in two different Canadian ED patient cohorts with serial hsTnI measurements. An undifferentiated ED population (Cohort-1) and an ED population with symptoms suggestive of acute coronary syndrome (ACS; Cohort-2) were clinically managed with non-hsTn testing with the hsTnI testing performed in real-time with physicians blinded to these results (i.e., hsTnI not reported). The three algorithms evaluated were the European Society of Cardiology (ESC), the High-STEACS pathway, and the COMPASS-MI algorithm. The diagnostic estimates were derived for each algorithm for the 30-day MI/death outcome for the rule-out and rule-in arm in each cohort and compared to proposed diagnostic benchmarks (i.e., sensitivity ≥ 99.0% and specificity ≥ 90.0%) with 95% confidence intervals (CI). In Cohort-1 (n = 2966 patients, 15.3% had outcome) and Cohort-2 (n = 935 patients, 15.6% had outcome), the algorithm that obtained the highest sensitivity (97.8%; 95% CI: 96.0–98.9 and 98.6%; 95% CI: 95.1–99.8, respectively) in both cohorts was COMPASS-MI. Only Cohort-2 with both the ESC and COMPASS-MI algorithms exceeded the specificity benchmark (97.0%; 95% CI: 95.5–98.0 and 96.7%; 95% CI: 95.2–97.8, respectively). Patient selection for serial hsTnI testing will affect specificity estimates, with no algorithm achieving a sensitivity ≥ 99% for 30-day MI or death.
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spelling pubmed-83971282021-08-28 Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting Kavsak, Peter A. Hewitt, Mark K. Mondoux, Shawn E. Cerasuolo, Joshua O. Ma, Jinhui Clayton, Natasha McQueen, Matthew Griffith, Lauren E. Perez, Richard Seow, Hsien Ainsworth, Craig Ko, Dennis T. Worster, Andrew J Cardiovasc Dev Dis Article Serial high-sensitivity cardiac troponin (hsTn) testing in the emergency department (ED) and the intensive cardiac care unit may assist physicians in ruling out or ruling in acute myocardial infarction (MI). There are three major algorithms proposed for high-sensitivity cardiac troponin I (hsTnI) using serial measurements while incorporating absolute concentration changes for MI or death following ED presentation. We sought to determine the diagnostic estimates of these three algorithms and if one was superior in two different Canadian ED patient cohorts with serial hsTnI measurements. An undifferentiated ED population (Cohort-1) and an ED population with symptoms suggestive of acute coronary syndrome (ACS; Cohort-2) were clinically managed with non-hsTn testing with the hsTnI testing performed in real-time with physicians blinded to these results (i.e., hsTnI not reported). The three algorithms evaluated were the European Society of Cardiology (ESC), the High-STEACS pathway, and the COMPASS-MI algorithm. The diagnostic estimates were derived for each algorithm for the 30-day MI/death outcome for the rule-out and rule-in arm in each cohort and compared to proposed diagnostic benchmarks (i.e., sensitivity ≥ 99.0% and specificity ≥ 90.0%) with 95% confidence intervals (CI). In Cohort-1 (n = 2966 patients, 15.3% had outcome) and Cohort-2 (n = 935 patients, 15.6% had outcome), the algorithm that obtained the highest sensitivity (97.8%; 95% CI: 96.0–98.9 and 98.6%; 95% CI: 95.1–99.8, respectively) in both cohorts was COMPASS-MI. Only Cohort-2 with both the ESC and COMPASS-MI algorithms exceeded the specificity benchmark (97.0%; 95% CI: 95.5–98.0 and 96.7%; 95% CI: 95.2–97.8, respectively). Patient selection for serial hsTnI testing will affect specificity estimates, with no algorithm achieving a sensitivity ≥ 99% for 30-day MI or death. MDPI 2021-08-13 /pmc/articles/PMC8397128/ /pubmed/34436239 http://dx.doi.org/10.3390/jcdd8080097 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kavsak, Peter A.
Hewitt, Mark K.
Mondoux, Shawn E.
Cerasuolo, Joshua O.
Ma, Jinhui
Clayton, Natasha
McQueen, Matthew
Griffith, Lauren E.
Perez, Richard
Seow, Hsien
Ainsworth, Craig
Ko, Dennis T.
Worster, Andrew
Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting
title Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting
title_full Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting
title_fullStr Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting
title_full_unstemmed Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting
title_short Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting
title_sort diagnostic performance of serial high-sensitivity cardiac troponin measurements in the emergency setting
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397128/
https://www.ncbi.nlm.nih.gov/pubmed/34436239
http://dx.doi.org/10.3390/jcdd8080097
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