Bedside high-sensitivity troponin rivals central-lab assays in MI detection

  • J Am Coll Cardiol

  • von Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • A point-of-care (POC) high-sensitivity cardiac troponin I (hs-cTnI) assay called TriageTrue performs very well in detecting and ruling out myocardial infarction (MI).
  • Authors derived, validated 0/1-hour algorithm that performed similarly to algorithms built on lab-based assays.
  • Prospective trials are needed.

Why this matters

  • Validated hs-cTnT/I 0/1-hour algorithms are recommended in current guidelines. 
  • Most are designed for use in central laboratories.
  • An accurate POC test could allow rule-outs in, e.g., ambulances and clinics.

Key results

  • Adjudicated final diagnosis:
    • MI, 14%.
    • Unstable angina, 9%.
    • Other cardiac cause: 17%.
    • Noncardiac: 57%.
    • Unknown: 4%.
  • Area under curve:
    • At presentation: 0.95 (95% CI, 0.93-0.96);
    • At 1 hour: 0.97 (95% CI, 0.95-0.98).
  • Cutoff
  • Negative predictive value: 100% (99.4%-100%);
  • Sensitivity: 100% (98.0%-100%). 
  • Cutoff >60 ng/L (95% CIs):
    • Positive predictive value: 76.8% (68.9%-83.6%);
    • Specificity: 97.1% (95.9%-98.0%).
  • After 0/1-hour rule-out, all-cause mortality:
    • 30 days: 0%;
    • 2 years: 1.6%.
  • Study design

    • Prospective multicenter APACE study of adults presenting to emergency departments with symptoms consistent with MI (n=1261).
    • Outcomes: diagnostic accuracy of test assay vs central lab assays (hs-cTnT-Elecsys and hs-cTnI-Architect).
    • Funding: Swiss, European nonprofits, universities; multiple industry funders.

    Limitations

    • Performance unknown if higher or lower pretest probability.