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Validation of an accelerated high‐sensitivity troponin T assay protocol in an Australian cohort with chest pain
Author(s) -
Parsonage William A,
Greenslade Jaimi H,
Hammett Christopher J,
Lamanna Arvin,
Tate Jillian R,
Ungerer Jacobus P,
Chu Kevin,
Than Martin,
Brown Anthony F T,
Cullen Louise
Publication year - 2014
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja13.10466
Subject(s) - medicine , chest pain , myocardial infarction , acute coronary syndrome , emergency department , prospective cohort study , troponin , cohort , cardiology , biomarker , troponin complex , cohort study , troponin t , emergency medicine , biochemistry , chemistry , psychiatry
Objectives: To validate an accelerated biomarker strategy using a high‐sensitivity cardiac troponin T (hs‐cTnT) assay for diagnosing acute myocardial infarction (AMI) in patients presenting to the emergency department with chest pain; and to validate this strategy in combination with the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand risk stratification model. Design, setting and patients: Single‐centre, prospective, observational cohort study of 764 adults presenting to a tertiary hospital with symptoms of possible acute coronary syndrome between November 2008 and February 2011. Main outcome measures: AMI or cardiac death within 24 hours of presentation (primary), and major adverse cardiac events within 30 days (secondary). Results: An elevated hs‐cTnT assay result above the 99th percentile at either the 0 h or 2 h time points had sensitivity of 96.4% (95% CI, 87.9%–99.0%), specificity of 82.6% (95% CI, 79.7%–85.2%), negative predictive value of 99.7% (95% CI, 98.8%–99.9%) and positive predictive value of 30.5% (95% CI, 24.2%–37.6%) for diagnosing AMI. Compared with a traditional 6 h cardiac troponin testing strategy, the accelerated strategy led to reclassification of risk in only two patients with adverse cardiac outcomes, with no net effect on appropriate management. Conclusions: In patients presenting with chest pain, an accelerated biomarker strategy using the hs‐cTnT assay performed well in the initial diagnosis of AMI. The accelerated strategy was also effective when incorporated into a comprehensive strategy of risk stratification that included clinical and demographic factors. The time saved by this approach could have a major impact on health service delivery. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN126153022.