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...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-08-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/8/8/97 |
| _version_ | 1797523442690424832 |
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| author | Peter A. Kavsak Mark K. Hewitt Shawn E. Mondoux Joshua O. Cerasuolo Jinhui Ma Natasha Clayton Matthew McQueen Lauren E. Griffith Richard Perez Hsien Seow Craig Ainsworth Dennis T. Ko Andrew Worster |
| author_facet | Peter A. Kavsak Mark K. Hewitt Shawn E. Mondoux Joshua O. Cerasuolo Jinhui Ma Natasha Clayton Matthew McQueen Lauren E. Griffith Richard Perez Hsien Seow Craig Ainsworth Dennis T. Ko Andrew Worster |
| author_sort | Peter A. Kavsak |
| collection | DOAJ |
| 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 (<i>n</i> = 2966 patients, 15.3% had outcome) and Cohort-2 (<i>n</i> = 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. |
| first_indexed | 2024-03-10T08:43:01Z |
| format | Article |
| id | doaj.art-8110ba31570b4fc5b94303e7bd3218bb |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-10T08:43:01Z |
| publishDate | 2021-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-8110ba31570b4fc5b94303e7bd3218bb2023-11-22T08:08:23ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252021-08-01889710.3390/jcdd8080097Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency SettingPeter A. Kavsak0Mark K. Hewitt1Shawn E. Mondoux2Joshua O. Cerasuolo3Jinhui Ma4Natasha Clayton5Matthew McQueen6Lauren E. Griffith7Richard Perez8Hsien Seow9Craig Ainsworth10Dennis T. Ko11Andrew Worster12Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaDivision of Emergency Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaDivision of Emergency Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, CanadaDepartment of Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaDepartment of Pathology and Molecular Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, CanadaICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, CanadaICES McMaster, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, CanadaDivision of Cardiology, McMaster University, Hamilton, ON L8S 4L8, CanadaICES Central, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, CanadaDivision of Emergency Medicine, McMaster University, Hamilton, ON L8S 4L8, CanadaSerial 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 (<i>n</i> = 2966 patients, 15.3% had outcome) and Cohort-2 (<i>n</i> = 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.https://www.mdpi.com/2308-3425/8/8/97deathmyocardial infarctionhigh-sensitivity cardiac troponinemergency departmentdiagnostic |
| spellingShingle | Peter A. Kavsak Mark K. Hewitt Shawn E. Mondoux Joshua O. Cerasuolo Jinhui Ma Natasha Clayton Matthew McQueen Lauren E. Griffith Richard Perez Hsien Seow Craig Ainsworth Dennis T. Ko Andrew Worster Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting Journal of Cardiovascular Development and Disease death myocardial infarction high-sensitivity cardiac troponin emergency department diagnostic |
| 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 | death myocardial infarction high-sensitivity cardiac troponin emergency department diagnostic |
| url | https://www.mdpi.com/2308-3425/8/8/97 |
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