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Peacock WF, Januzzi JL, de Theije F, Briseno T, Headden G, Birkhahn R, Allen BR, Mahler SA. Methods of the PivotaL triAl of the Atellica VTLi point of care emergencY dePartment high sensitivity troponin evalUationS. Clin Biochem 2023; 121-122:110679. [PMID: 37884085 DOI: 10.1016/j.clinbiochem.2023.110679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The Atellica® VTLi point-of-care (POC) High Sensitivity Cardiac Troponin-I (hs-cTnI) assay is intended for use as an aid in the diagnosis of myocardial infarction (MI). Our primary objective is to assess its diagnostic performance in patients presenting with suspected acute coronary syndrome (ACS). METHODS This prospective observational study will enrol ∼1500 patients at ∼20 U.S. Emergency Departments. After informed consent, adults (>21 years of age) with suspected ACS, and no prior enrollment in this study, will provide a fingerstick and venous blood sample within 2 h of ED presentation, >2 to ≤4 h, and >4 to ≤9 h (max. blood draw = 60 mL). HEART and EDACS scores will be prospectively documented. Patients without the first blood draw may be enrolled if the second draw was obtained. Capillary and venous whole blood will undergo Atellica VTLi assay testing, with remaining venous sample processed to plasma and run. All results will be blinded to the clinical care team. Site operators will undergo a 3-day familiarization period. Quality control testing will be performed daily. At 30 ± 3 days, patient mortality status, major adverse cardiac events, and rehospitalizations will be determined. A clinical endpoint adjudication committee, blinded to hs-cTnI VTLi result, will define the final diagnosis. Sensitivity, specificity, and predictive values will describe the assay performance. RESULTS We expect study completion within 114 weeks of enrollment of the first patient. CONCLUSIONS It is anticipated that the Atellica VTLi hs-cTnI assay validation study will define a performance equivalent to lab-based hs-cTnI, with results within ∼8 min at the point of care.
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Affiliation(s)
| | | | - Femke de Theije
- Siemens Healthineers Headquarters, Siemens Healthcare GmbH, Henkestr. 127, 91052 Erlangen, Germany
| | - Taylor Briseno
- Siemens Healthineers Headquarters, Siemens Healthcare GmbH, Henkestr. 127, 91052 Erlangen, Germany
| | - Gary Headden
- Medical University of South Carolina, United States
| | | | | | - Simon A Mahler
- Wake Forest University School of Medicine, United States
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Peacock WF, Diercks D, Birkhahn R, Singer AJ, Hollander JE, Nowak R, Safdar B, Miller CD, Peberdy M, Counselman F, Chandra A, Kosowsky J, Neuenschwander J, Schrock J, Lee-Lewandrowski E, Arnold W, Nagurney J. Can a Point-of-Care Troponin I Assay be as Good as a Central Laboratory Assay? A MIDAS Investigation. Ann Lab Med 2017; 36:405-12. [PMID: 27374704 PMCID: PMC4940482 DOI: 10.3343/alm.2016.36.5.405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/10/2016] [Accepted: 05/26/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We aimed to compare the diagnostic accuracy of the Alere Triage Cardio3 Tropinin I (TnI) assay (Alere, Inc., USA) and the PathFast cTnI-II (Mitsubishi Chemical Medience Corporation, Japan) against the central laboratory assay Singulex Erenna TnI assay (Singulex, USA). METHODS Using the Markers in the Diagnosis of Acute Coronary Syndromes (MIDAS) study population, we evaluated the ability of three different assays to identify patients with acute myocardial infarction (AMI). The MIDAS dataset, described elsewhere, is a prospective multicenter dataset of emergency department (ED) patients with suspected acute coronary syndrome (ACS) and a planned objective myocardial perfusion evaluation. Myocardial infarction (MI) was diagnosed by central adjudication. RESULTS The C-statistic with 95% confidence intervals (CI) for diagnosing MI by using a common population (n=241) was 0.95 (0.91-0.99), 0.95 (0.91-0.99), and 0.93 (0.89-0.97) for the Triage, Singulex, and PathFast assays, respectively. Of samples with detectable troponin, the absolute values had high Pearson (R(P)) and Spearman (R(S)) correlations and were R(P)=0.94 and R(S)=0.94 for Triage vs Singulex, R(P)=0.93 and R(S)=0.85 for Triage vs PathFast, and R(P)=0.89 and R(S)=0.73 for PathFast vs Singulex. CONCLUSIONS In a single comparative population of ED patients with suspected ACS, the Triage Cardio3 TnI, PathFast, and Singulex TnI assays provided similar diagnostic performance for MI.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mary Peberdy
- Virginia Commonwealth University Health Systems, Richmond, VA, USA
| | | | | | | | | | - Jon Schrock
- Metrohealth Medical Center, Cleveland, OH, USA
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Abstract
Accurate and rapid diagnostic tests can help identify high-risk patients with ACS among those presenting to the emergency department with chest pain. Such tests can also differentiate low-risk patients with chest pain who are suitable for early emergency department discharge. In this article, Drs Amsterdam and Deedwania elucidate the varieties of ACS, their pathophysiology, and the methods used for diagnosis. The authors also explore the potential of point-of-care testing for cardiac injury markers in the timely and accurate identification of ACS.
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Peacock WF, Cullen L, Mueller C, Than M. Troponin testing: End of an era? Clin Biochem 2013; 46:1627-8. [DOI: 10.1016/j.clinbiochem.2013.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 03/12/2013] [Accepted: 03/15/2013] [Indexed: 11/16/2022]
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Petrich W, Lewandrowski KB, Muhlestein JB, Hammond MEH, Januzzi JL, Lewandrowski EL, Pearson RR, Dolenko B, Früh J, Haass M, Hirschl MM, Köhler W, Mischler R, Möcks J, Ordóñez–Llanos J, Quarder O, Somorjai R, Staib A, Sylvén C, Werner G, Zerback R. Potential of mid-infrared spectroscopy to aid the triage of patients with acute chest pain. Analyst 2009; 134:1092-8. [DOI: 10.1039/b820923e] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Giannitsis E, Baum H, Bertsch T, Juchum M, Müller-Bardorff M, Jørgensen B, Böhmer A, Rebmann M, Schäffler J, Schwab M, Zerback R. Multicentre evaluation of a new point-of-care test for the determination of CK-MB in whole blood. Clin Chem Lab Med 2008; 46:630-8. [DOI: 10.1515/cclm.2008.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kost GJ, Tran NK. Point-of-Care Testing and Cardiac Biomarkers: The Standard of Care and Vision for Chest Pain Centers. Cardiol Clin 2005; 23:467-90, vi. [PMID: 16278118 DOI: 10.1016/j.ccl.2005.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Point-of-care testing (POCT) is defined as testing at or near the site of patient care. POCTdecreases therapeutic turnaround time (TTAT), increases clinical efficiency, and improves medical and economic outcomes. TTAT represents the time from test ordering to patient treatment. POC technologies have become ubiquitous in the United States, and, therefore,so has the potential for speed, convenience, and satisfaction, strong advantages for physicians, nurses, and patients in chest pain centers. POCT is applied most beneficially through the collaborative teamwork of clinicians and laboratorians who use integrative strategies, performance maps, clinical algorithms, and care paths (critical pathways). For example, clinical investigators have shown that on-site integration of testing for cardiac injury markers (myoglobin, creatinine kinase myocardial band [CKMB],and cardiac troponin I [cTnI]) in accelerated diagnostic algorithms produces effective screening, less hospitalization, and substantial savings. Chest pain centers, which now total over 150 accredited in the United States, incorporate similar types of protocol-driven performance enhancements. This optimization allows chest pain centers to improve patient evaluation, treatment, survival, and discharge. This article focuses on cardiac biomarker POCT for chest pain centers and emergency medicine.
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Affiliation(s)
- Gerald J Kost
- Point-of-Care Testing Center for Teaching and Research, Department of Pathology and Laboratory Medicine,UCD Health System, School of Medicine, University of California, Davis, CA 95616, USA.
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Ordóñez-Llanos J, Santaló-Bel M, Mercé-Muntañola J, Collinson PO, Gaze D, Haass M, Katus HA, Chwallek F, Hirschl MM, Derhaschnig U, Mueller-Bardorff M, Kellett J, Sylvén C, Schulz I, Zerback R. Risk stratification of chest pain patients by point-of-care cardiac troponin T and myoglobin measured in the emergency department. Clin Chim Acta 2005; 365:93-7. [PMID: 16214122 DOI: 10.1016/j.cca.2005.07.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Revised: 07/20/2005] [Accepted: 07/21/2005] [Indexed: 11/23/2022]
Abstract
A prospective multicenter study including 1410 chest pain patients with suspected acute coronary syndromes was carried out to examine the predictive value of biological cardiac markers for adverse events measured by a point-of-care system. Admission cardiac troponin T (cTnT) and myoglobin were measured in parallel on a point-of-care system in the emergency department and -- together with CK-MB mass -- on lab analyzers. In a one-year follow-up, cardiac and non-cardiac death, acute myocardial infarction, unstable angina pectoris and need for revascularization were registered. Median time between onset of symptoms and admission was 285 min; 172 patients (12.2%) had no event during follow-up. If the cTnT, measured either by the point-of-care system or a conventional lab analyzer, was >0.05 microg/L, then the chance of a cardiac event during the follow-up period was doubled (18% vs. 9%). Serial cTnT measurement did not add any further value to the predictive power of the admission cTnT. Myoglobin and CK-MB mass identified increasing risk with increasing concentration quartiles; cardiac event rates were 2.8- to 4.4-fold higher between the quartiles with the lowest and those with the highest analyte concentration, respectively. There was no difference in non-cardiac death rates between any concentration quartiles. In conclusion, the prediction of clinical events by cardiac troponin T and myoglobin measured with a point-of-care analyzer in the emergency department was as good as that of the same cardiac markers and CK-MB mass measured on lab analyzers.
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