- 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.
- 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).
- Negative predictive value: 100% (99.4%-100%);
- Sensitivity: 100% (98.0%-100%).
- Positive predictive value: 76.8% (68.9%-83.6%);
- Specificity: 97.1% (95.9%-98.0%).
- 30 days: 0%;
- 2 years: 1.6%.
- 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.
- Performance unknown if higher or lower pretest probability.