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Zalama-Sánchez D, del Pozo Vegas C, Sanz-García A, de Santos-Castro PÁ, Presencio-Dominguez J, González-Izquierdo P, Sánchez-Ramón S, Pinilla-Arribas LT, Baladrón-Segura M, Cheayeb-Morán J, Fernandez-García M, Velasco de Cos G, López-Izquierdo R, Martín-Rodríguez F. Diagnostic Performance of Point-of-Care High-Sensitivity Troponin in the Exclusion of Non-ST-Elevation Myocardial Infarction in the Emergency Department. J Pers Med 2024; 14:762. [PMID: 39064016 PMCID: PMC11277698 DOI: 10.3390/jpm14070762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/12/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study evaluates the diagnostic performance of high-sensitivity troponin using point-of-care testing (POCT) devices compared with main laboratory measurements for ruling out non-ST-elevation myocardial infarction (NSTEMI) in emergency department (ED) patients presenting with non-traumatic chest pain. METHODS This multicenter, observational, prospective, non-interventional study was conducted in two Spanish hospitals from 1 June to 31 December 2023 and included adult patients presenting with non-traumatic chest pain admitted to the ED. High-sensitivity troponin levels were measured using both the Siemens Atellica® VTLi POCT device and main laboratory testing, with data collected on analytical results and measurement times. RESULTS Of the 201 patients who met the inclusion criteria, a significant correlation was observed between the POCT and laboratory assays. The area under the curve (AUC) of the ROC curve was consistently greater than 0.9, indicating a high diagnostic accuracy for ruling out NSTEMI. In addition, measurement times were significantly reduced using POCT compared to the core laboratory. CONCLUSION These results suggest that high-sensitivity troponin POCT devices offer comparable diagnostic performance to traditional laboratory methods for the diagnosis of NSTEMI in the emergency department, potentially speeding up clinical decisions and optimizing resource utilization.
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Affiliation(s)
- Daniel Zalama-Sánchez
- Emergency Department, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Carlos del Pozo Vegas
- Faculty of Medicine, University of Valladolid, 47002 Valladolid, Spain; (C.d.P.V.); (R.L.-I.); (F.M.-R.)
- Emergency Department, Hospital Clínico Universitario, 47003 Valladolid, Spain; (P.Á.d.S.-C.); (P.G.-I.); (L.T.P.-A.); (J.C.-M.)
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla la Mancha, 45600 Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla La Mancha, 45004 Toledo, Spain
- Evaluación de Cuidados de Salud (ECUSAL), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Pedro Ángel de Santos-Castro
- Emergency Department, Hospital Clínico Universitario, 47003 Valladolid, Spain; (P.Á.d.S.-C.); (P.G.-I.); (L.T.P.-A.); (J.C.-M.)
| | | | - Pablo González-Izquierdo
- Emergency Department, Hospital Clínico Universitario, 47003 Valladolid, Spain; (P.Á.d.S.-C.); (P.G.-I.); (L.T.P.-A.); (J.C.-M.)
| | - Susana Sánchez-Ramón
- Emergency Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain; (J.P.-D.); (S.S.-R.)
| | - Leyre Teresa Pinilla-Arribas
- Emergency Department, Hospital Clínico Universitario, 47003 Valladolid, Spain; (P.Á.d.S.-C.); (P.G.-I.); (L.T.P.-A.); (J.C.-M.)
| | - Manuel Baladrón-Segura
- Clinical Analysis Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain; (M.B.-S.); (M.F.-G.)
| | - Jaldún Cheayeb-Morán
- Emergency Department, Hospital Clínico Universitario, 47003 Valladolid, Spain; (P.Á.d.S.-C.); (P.G.-I.); (L.T.P.-A.); (J.C.-M.)
| | - María Fernandez-García
- Clinical Analysis Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain; (M.B.-S.); (M.F.-G.)
| | | | - Raúl López-Izquierdo
- Faculty of Medicine, University of Valladolid, 47002 Valladolid, Spain; (C.d.P.V.); (R.L.-I.); (F.M.-R.)
- Emergency Department, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain; (J.P.-D.); (S.S.-R.)
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, 47002 Valladolid, Spain; (C.d.P.V.); (R.L.-I.); (F.M.-R.)
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
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Gou Q, Liang L, Liu D, Jia J, Dong M, Chen H, Shou X. Clinical performance of 0/1 h cardiac troponin algorithm for diagnosing non-ST-segment elevation myocardial infarction in an emergency setting. Am J Emerg Med 2023; 71:139-143. [PMID: 37392513 DOI: 10.1016/j.ajem.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) is a common form of acute myocardial infarction and rapid and accurate diagnosis is crucial for timely treatment. Current guidelines recommend using high-sensitivity cardiac troponin (hs-cTn) assays to determine circulating cTnI or cTnT levels. While the accuracy of the 0 h/1 h algorithm for diagnosing NSTEMI in different regions and patient populations remains controversial. Additionally, point-of-care testing (POCT) cTn assays have the potential to provide troponin readings to physicians within 15 min, but their accuracy in diagnosing NSTEMI in the emergency department (ED) requires further investigation. METHODS A single-center prospective observational cohort study was conducted at Shaanxi Provincial People's Hospital to assess the analytical and diagnostic performance of the laboratory-based Roche Modular E170 hs-cTnT using the 0 h/1 h algorithm with Radiometer AQT90-flex POCT cTnT assay in undifferentiated chest pain patients presenting to the ED. Whole-blood samples were collected and hs-cTnT and POCT cTnI were measured simultaneously at baseline and after 1 h. RESULTS The study results showed that the POCT cTnT assay using the 0 h/1 h algorithm had comparable diagnostic accuracy to the laboratory-based Roche Modular E170 hs-cTnT assay in diagnosing NSTEMI in patients with chest pain. CONCLUSION The laboratory-based Roche Modular E170 hs-cTnT using the 0 h/1 h algorithm is reliable and accurate method for diagnosing NSTEMI in undifferentiated chest pain patients presenting to the ED. POCT cTnT assay has comparable diagnostic accuracy to the hs-cTnT assay and its rapid turnaround time makes it a valuable tool in expediting the diagnostic workup of chest pain patients.
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Affiliation(s)
- Qiling Gou
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Linyuan Liang
- Department of Cardiovascular Medicine, Xi'an international medical center hospital, Xi'an 710032, Shaanxi, China
| | - Danping Liu
- Department of Emergency Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Jia Jia
- Department of Emergency Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Mengya Dong
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China
| | - Haichao Chen
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China.
| | - Xiling Shou
- Department of Cardiovascular Medicine, Shaanxi Provincial People's Hospital, Xi'an 710032, Shaanxi, China.
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Comparison of Point-of-Care and Highly Sensitive Laboratory Troponin Testing in Patients Suspicious of Acute Myocardial Infarction and Its Efficacy in Clinical Outcome. Cardiol Res Pract 2022; 2022:6914979. [PMID: 35251711 PMCID: PMC8894057 DOI: 10.1155/2022/6914979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/07/2022] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background The use of high-sensitivity troponin (hs-cTnI) assays is recommended in current guidelines for managing patients with acute coronary syndrome (ACS) symptoms. However, point-of-care (POC) assays are frequently used in emergency departments (EDs) to reduce turnaround time and length of stay. This study aimed to compare the results of POC-cTnI testing with those of the gold standard, automated central laboratory testing of troponin (i.e., hs-cTnI). The primary and secondary outcomes were the diagnostic performance of POC-cTnI in diagnosing acute myocardial infarction (AMI) and major adverse cardiovascular events (MACE) during 30 days, respectively. Materials and Methods In this diagnostic accuracy study, 136 patients with suspected ACS who were referred or admitted to the Al Zahra Hospital, Shiraz, Iran, were included between March (2020) and July (2020). For the diagnosis of AMI, central laboratory cTnI levels were assessed at the time of presentation (0 hour) and reassessed at least 3 hours later. The POC-cTnI was measured at 0 hour in all patients and at 3 hours if a patient was diagnosed with AMI but had a 0-hour negative result for the POC-cTnI assay. Additionally, the 30-day follow-up period for these participants began on the day of the initial presentation to assess MACE. Results Out of 180 patients, 136 patients (median age of 59.5 years; 57.5% male) were left for the qualitative POC-cTnI and hs-cTnI assays. In 86 (63.24%) subjects, hs-cTnI was positive (either initial or serial); however, AMI was diagnosed in 85 patients according to positivity of troponin by hs-cTnI and clinical signs and symptoms, which were diagnosed by a cardiologist. The sensitivity, specificity, and negative predictive value of 0-hour POC-cTnI were observed to be 91.76% (95% CI: 83.77–96.62%), 98.04% (95% CI: 89.55–99.95%), and 87.72% (95% CI: 77.82–93.56%), respectively. Moreover, considering both the 0-hour and 3-hour POC-cTnI, all AMI cases were correctly identified, yielding a perfect test performance result. None of the 50 patients with negative cTnI results (by 0-hour and 3-hour POC-cTnI and hs-cTnI) experienced at least one MACE. Conclusion In this small sample-size study, a new qualitative POC-cTnI assay was statistically equal to a hs-cTnI assay in terms of diagnostic accuracy for AMI or MACE in patients with suspected myocardial infarction. The POC-cTnI was observed to be acceptable for the identification of AMI and prediction of MACE in the ED environment.
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