Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an Emergency Department : A clinical cohort study
Copyright © 2016 Elsevier Ireland Ltd. All rights reserved..
BACKGROUND: A point of care test (POCT) for troponin T (TnT) in the Emergency Department (ED) was compared to a high-sensitivity TnT (hsTnT) central laboratory test (CLT) to determine the influence of test system and different cut-off values on the diagnostic performance in patients with suspected acute coronary syndrome (ACS) under routine conditions.
METHODS: All patients with routine TnT testing in the ED were enrolled. Only internal medicine patients without STEMI and with both troponin values were analyzed. TnT was measured with a contemporary sensitive POCT assay in the ED and with a hs-assay in the central laboratory. The diagnostic performance was analyzed at two different cut-off points (99th percentile and conventional rule-in cut-offs). Primary endpoint was the diagnosis of NSTEMI.
RESULTS: Of all patients (n=3423), 3.6% had a diagnosis of NSTEMI (n=124). For the hsTnT assay, 28.4% of all values were at or below the lower limit of detection (LOD) as compared to 75.7% of the POC-TnT-values. The area under the receiver operating curves did not differ significantly between the assays (hsTnT: 0.912(95%-CI: 0.884-0.940); POC-TnT: 0.896(95%-CI: 0.859-0.933)). The diagnostic performance was very similar for both assays: the positive predictive value was below 50% for troponin values below 100ng/L and hardly increased for values between 100 and 600ng/L for hs and conventional assays.
CONCLUSIONS: In our cohort of emergency patients, the diagnostic performance of conventional POC-testing was comparable to hsTnT. A 99th percentile cut-off may be useful for rule-out of NSTEMI, but seems limited for routine rule-in strategies.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:230 |
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| Enthalten in: |
International journal of cardiology - 230(2017) vom: 01. März, Seite 454-460 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Slagman, Anna [VerfasserIn] |
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| Links: |
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| Themen: |
Acute coronary syndrome |
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| Anmerkungen: |
Date Completed 27.11.2017 Date Revised 28.11.2017 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ijcard.2016.12.085 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM267600577 |
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| 100 | 1 | |a Slagman, Anna |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an Emergency Department |b A clinical cohort study |
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| 500 | |a Date Revised 28.11.2017 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2016 Elsevier Ireland Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: A point of care test (POCT) for troponin T (TnT) in the Emergency Department (ED) was compared to a high-sensitivity TnT (hsTnT) central laboratory test (CLT) to determine the influence of test system and different cut-off values on the diagnostic performance in patients with suspected acute coronary syndrome (ACS) under routine conditions | ||
| 520 | |a METHODS: All patients with routine TnT testing in the ED were enrolled. Only internal medicine patients without STEMI and with both troponin values were analyzed. TnT was measured with a contemporary sensitive POCT assay in the ED and with a hs-assay in the central laboratory. The diagnostic performance was analyzed at two different cut-off points (99th percentile and conventional rule-in cut-offs). Primary endpoint was the diagnosis of NSTEMI | ||
| 520 | |a RESULTS: Of all patients (n=3423), 3.6% had a diagnosis of NSTEMI (n=124). For the hsTnT assay, 28.4% of all values were at or below the lower limit of detection (LOD) as compared to 75.7% of the POC-TnT-values. The area under the receiver operating curves did not differ significantly between the assays (hsTnT: 0.912(95%-CI: 0.884-0.940); POC-TnT: 0.896(95%-CI: 0.859-0.933)). The diagnostic performance was very similar for both assays: the positive predictive value was below 50% for troponin values below 100ng/L and hardly increased for values between 100 and 600ng/L for hs and conventional assays | ||
| 520 | |a CONCLUSIONS: In our cohort of emergency patients, the diagnostic performance of conventional POC-testing was comparable to hsTnT. A 99th percentile cut-off may be useful for rule-out of NSTEMI, but seems limited for routine rule-in strategies | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute coronary syndrome | |
| 650 | 4 | |a Diagnostic performance | |
| 650 | 4 | |a High sensitive troponin | |
| 650 | 4 | |a Non-ST elevation myocardial infarction | |
| 650 | 4 | |a Point of care testing | |
| 650 | 7 | |a Troponin T |2 NLM | |
| 700 | 1 | |a von Recum, Johannes |e verfasserin |4 aut | |
| 700 | 1 | |a Möckel, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Holert, Fabian |e verfasserin |4 aut | |
| 700 | 1 | |a Meyer Zum Büschenfelde, Dirk |e verfasserin |4 aut | |
| 700 | 1 | |a Müller, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Searle, Julia |e verfasserin |4 aut | |
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