ISSN 2996-8215
International Journal of Cardiology | Vol. 9, No. 7, July 2018 | pp. 49–56
DOI: 10.46882/2018/IJC/000112
Original Research Article
Diagnostic Utility of High-Sensitivity Cardiac Troponin I vs T Rapid 1-Hour Rule-Out Strategies for Suspected ACS
Chloe Jenkins¹, Oliver Vance¹, Sarah E. Lawson²
¹Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
²School of Medicine, University of Queensland, Brisbane, Queensland, Australia
Abstract:
Accelerated diagnostic protocols using high-sensitivity cardiac troponin (hs-cTn) assays have dramatically reduced emergency department (ED) evaluation times for suspected acute myocardial infarction (AMI). However, a direct comparison between high-sensitivity troponin I (hs-cTnI) and high-sensitivity troponin T (hs-cTnT) rapid 1-hour rule-out strategies is limited. This prospective diagnostic study compared the safety and efficacy of 1-hour rule-out algorithms using hs-cTnI versus hs-cTnT in patients presenting with acute chest pain. We evaluated 450 consecutive patients presenting to the ED with chest pain suggestive of acute coronary syndrome. Serial blood samples were drawn at presentation (0h) and 1 hour later for both hs-cTnI and hs-cTnT quantification. The final diagnosis of AMI was adjudicated by an independent clinical panel. AMI was diagnosed in 62 patients (13.8%). The hs-cTnI 1h algorithm successfully ruled out AMI in 61.3% of patients, yielding a diagnostic sensitivity of 98.4% (95% CI: 91.3%–99.9%) and a negative predictive value (NPV) of 99.6% (95% CI: 98.0%–99.9%). The hs-cTnT 1h algorithm ruled out AMI in 58.4% of patients, providing a sensitivity of 96.8% (95% CI: 88.8%–99.6%) and an NPV of 99.2% (95% CI: 97.3%–99.9%). The area under the receiver operating characteristic curve was comparable between hs-cTnI and hs-cTnT (0.94 vs. 0.92, p = 0.35). No patient categorized as safe for rule-out by either assay experienced a major adverse cardiac event within 30 days. Both hs-cTnI and hs-cTnT 1-hour algorithms provide safe, highly efficient triage for ruling out acute myocardial infarction in the emergency department.
Keywords: High-sensitivity cardiac troponin, Acute myocardial infarction, Emergency department, Chest pain, Rapid rule-out, Diagnostic accuracy
Received: April 02, 2013; Revised: May 15, 2013; Accepted: June 08, 2013; Published: July 20, 2018