Abstract
Background:
Point of care (POC) assays for cardiac troponins I or T (cTnI or cTnT) may accelerate the diagnosis of patients with suspected acute coronary syndrome (ACS). However, their clinical utility according to the 0 h/3 h algorithm recommended by the European Society of Cardiology (ESC) for non-ST elevation myocardial infarction (NSTEMI) is unknown.
Methods:
Blood samples from 90 patients with suspected ACS were obtained at hospital admission and 3 h later. Concentrations of cTn were determined using five POC assays (AQT90 FLEX cTnI and cTnT; PATHFAST™ cTnI; Stratus CS 200 cTnI; and Triage MeterPro cTnI) and two guideline-acceptable high-sensitivity (hs) immunoassays.
Results:
For the diagnosis of NSTEMI (n=15), AUCs for Abbott hs-cTnI and Roche hs-cTnT were 0.86 [95% confidence interval (CI), 0.75–0.96] and 0.88 (95% CI, 0.80–0.95), respectively, at admission, and 0.96 and 0.94, respectively, 3 h later. With the 99th percentile cutoff, their sensitivities were 62% and 92%, respectively, at admission, and 77% and 100%, respectively, 3 h later. The PATHFAST™ cTnI assay showed AUCs of 0.90 (95% CI, 0.82–0.97) and 0.94 (95% CI, 0.89–1.00), respectively, and sensitivities of 67% and 75% at admission and 3 h later, respectively. The other cTn POC assays had AUCs of 0.71 (95% CI, 0.53–0.89) to 0.84 (95% CI, 0.71–0.96) and 0.86 (95% CI, 0.72–0.99) to 0.87 (95% CI, 0.75–0.99) and sensitivities of 39%–50% and 62%–77% at admission and 3 h later, respectively.
Conclusions:
PATHFAST™ cTnI assay proved itself as comparable to ESC-guideline acceptable hs-cTn assays. The lower sensitivity of the other POC assays limits their clinical utility and would require longer follow-up monitoring of patients for the safe NSTEMI rule-out.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569–619.10.1016/j.rec.2012.10.010Search in Google Scholar
2. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ECS guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the european society of cardiology (ECS). Eur Heart J 2016;37:267–315.10.1093/eurheartj/ehv320Search in Google Scholar
3. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012;60:1581–98.10.1016/j.jacc.2012.08.001Search in Google Scholar
4. Apple FS. A new season for cardiac troponin assays: it’s time to keep a scorecard. Clin Chem 2009;55:1303–6.10.1373/clinchem.2009.128363Search in Google Scholar
5. Novis DA, Jones BA, Dale JC, Walsh MK, College of American P. Biochemical markers of myocardial injury test turnaround time: a College of American Pathologists Q-Probes study of 7020 troponin and 4368 creatine kinase-mb determinations in 159 institutions. Arch Pathol Lab Med 2004;128:158–64.10.5858/2004-128-158-BMOMITSearch in Google Scholar
6. Ryan RJ, Lindsell CJ, Hollander JE, O’Neil B, Jackson R, Schreiber D, et al. A multicenter randomized controlled trial comparing central laboratory and point-of-care cardiac marker testing strategies: the disposition impacted by serial point of care markers in acute coronary syndromes (dispo-acs) trial. Ann Emerg Med 2009;53:321–8.10.1016/j.annemergmed.2008.06.464Search in Google Scholar
7. Nilsson S, Andersson A, Janzon M, Karlsson JE, Levin LA. Cost consequences of point-of-care troponin T testing in a swedish primary health care setting. Scand J Prim Health Care 2014;32:241–7.10.3109/02813432.2014.984901Search in Google Scholar
8. Ezekowitz JA, Welsh RC, Weiss D, Chan M, Keeble W, Khadour F, et al. Providing rapid out of hospital acute cardiovascular treatment 4 (proact-4). J Am Heart Assoc 2015;4:e002859.10.1161/JAHA.115.002859Search in Google Scholar
9. Goodacre S, Bradburn M, Fitzgerald P, Cross E, Collinson P, Gray A, et al. The RATPAC (Randomised Assessment of Treatment using Panel Assay of Cardiac markers) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department. Health Technol Assess 2011;15:iii–xi.10.3310/hta15230Search in Google Scholar
10. Jaffe AS, Apple FS, Morrow DA, Lindahl B, Katus HA. Being rational about (im)precision: a statement from the biochemistry subcommittee of the joint european society of cardiology/american college of cardiology foundation/american heart association/world heart federation task force for the definition of myocardial infarction. Clin Chem 2010;56:941–3.10.1373/clinchem.2010.143958Search in Google Scholar
11. Reiter M, Twerenbold R, Reichlin T, Benz B, Haaf P, Meissner J, et al. Early diagnosis of acute myocardial infarction in patients with pre-existing coronary artery disease using more sensitive cardiac troponin assays. Eur Heart J 2012;33:988–97.10.1093/eurheartj/ehr376Search in Google Scholar
12. Cullen L, Aldous S, Than M, Greenslade JH, Tate JR, George PM, et al. Comparison of high sensitivity troponin T and I assays in the diagnosis of non-ST elevation acute myocardial infarction in emergency patients with chest pain. Clin Biochem 2014;47:321–6.10.1016/j.clinbiochem.2013.11.019Search in Google Scholar
13. Clerico A, Giannoni A, Prontera C, Giovannini S. High-sensitivity troponin: A new tool for pathophysiological investigation and clinical practice. Adv Clin Chem 2009;49:1–30.10.1016/S0065-2423(09)49001-2Search in Google Scholar
14. Hjortshoj S, Venge P, Ravkilde J. Clinical performance of a new point-of-care cardiac troponin I assay compared to three laboratory troponin assays. Clin Chim Acta 2011;412:370–5.10.1016/j.cca.2010.11.015Search in Google Scholar
15. Slagman A, von Recum J, Mockel M, Holert F, Meyer Zum Buschenfelde D, Muller C, et al. Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an emergency department: a clinical cohort study. Int J Cardiol 2017;230:454–60.10.1016/j.ijcard.2016.12.085Search in Google Scholar
Supplemental Material:
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-0486).
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