Validation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain.

Abstract

OBJECTIVES:

To validate an accelerated biomarker strategy using a high-sensitivity cardiac troponin T (hs-cTnT) assay for diagnosing acute myocardial infarction (AMI) in patients presenting to the emergency department with chest pain; and to validate this strategy in combination with the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand risk stratification model.

DESIGN, SETTING AND PATIENTS:

Single-centre, prospective, observational cohort study of 764 adults presenting to a tertiary hospital with symptoms of possible acute coronary syndrome between November 2008 and February 2011.

MAIN OUTCOME MEASURES:

AMI or cardiac death within 24 hours of presentation (primary), and major adverse cardiac events within 30 days (secondary).

RESULTS:

An elevated hs-cTnT assay result above the 99th percentile at either the 0 h or 2 h time points had sensitivity of 96.4% (95% CI, 87.9%-99.0%), specificity of 82.6% (95% CI, 79.7%-85.2%), negative predictive value of 99.7% (95% CI, 98.8%-99.9%) and positive predictive value of 30.5% (95% CI, 24.2%-37.6%) for diagnosing AMI. Compared with a traditional 6 h cardiac troponin testing strategy, the accelerated strategy led to reclassification of risk in only two patients with adverse cardiac outcomes, with no net effect on appropriate management.

CONCLUSIONS:

In patients presenting with chest pain, an accelerated biomarker strategy using the hs-cTnT assay performed well in the initial diagnosis of AMI. The accelerated strategy was also effective when incorporated into a comprehensive strategy of risk stratification that included clinical and demographic factors. The time saved by this approach could have a major impact on health service delivery.

TRIAL REGISTRATION:

Australian New Zealand Clinical Trials Registry ACTRN12610000053022.

• Authors: William A Parsonage, Jaimi H Greenslade, Christopher J Hammett, Arvin Lamanna, Jillian R Tate, Jacobus P Ungerer, Kevin Chu, Martin Than, Anthony F T Brown, Louise Cullen
• Journal: The Medical journal of Australia (Med J Aust) Vol. 200 Issue 3 Pg. 161-5 (Feb 17 2014) ISSN: 1326-5377 [Electronic] Australia
• PMID: 24528432 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't, Validation Study)

Chemical References

• Troponin T

Topics

• Acute Coronary Syndrome (diagnosis)
• Adult
• Aged
• Biological Assay (methods)
• Chest Pain
• Cohort Studies
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis)
• Prospective Studies
• Risk Assessment
• Risk Factors
• Sensitivity and Specificity
• Troponin T (blood)