Adopting ‘ng/L’ as the units for high-sensitivity cardiac troponin assays and commitment by the entire health-care team could be the key for adopting recommendations

Kufaishi, Hala; Pardhan, Alim; Krizmanich, William; Worster, Andrew; Hill, Stephen A.; Kavsak, Peter A.

doi:10.1177/0004563215613533

Cited by 8 publications

(1 citation statement)

References 12 publications

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“…The Abbott ARCHITECT hsTnI assay was measured in both cohorts with acceptable precision and performance documented for this assay [13,17]. In Cohort-1, there was no clinical recommendation on early sampling so a second sample was collected per standard care (reported median (25th to 75th) = 7.2 h (4.3 to 8.8) from presentation sample) [23]. In Cohort-2, there was a clinical recommendation to collect samples 3 h apart as per the Canadian Institutes of Health Research funded grant and study protocol [24].…”

Section: Laboratory Testing and Algorithms Evaluatedmentioning

confidence: 99%

Diagnostic Performance of Serial High-Sensitivity Cardiac Troponin Measurements in the Emergency Setting

Kavsak

Hewitt

Mondoux

et al. 2021

JCDD

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Serial high-sensitivity cardiac troponin (hsTn) testing in the emergency department (ED) and the intensive cardiac care unit may assist physicians in ruling out or ruling in acute myocardial infarction (MI). There are three major algorithms proposed for high-sensitivity cardiac troponin I (hsTnI) using serial measurements while incorporating absolute concentration changes for MI or death following ED presentation. We sought to determine the diagnostic estimates of these three algorithms and if one was superior in two different Canadian ED patient cohorts with serial hsTnI measurements. An undifferentiated ED population (Cohort-1) and an ED population with symptoms suggestive of acute coronary syndrome (ACS; Cohort-2) were clinically managed with non-hsTn testing with the hsTnI testing performed in real-time with physicians blinded to these results (i.e., hsTnI not reported). The three algorithms evaluated were the European Society of Cardiology (ESC), the High-STEACS pathway, and the COMPASS-MI algorithm. The diagnostic estimates were derived for each algorithm for the 30-day MI/death outcome for the rule-out and rule-in arm in each cohort and compared to proposed diagnostic benchmarks (i.e., sensitivity ≥ 99.0% and specificity ≥ 90.0%) with 95% confidence intervals (CI). In Cohort-1 (n = 2966 patients, 15.3% had outcome) and Cohort-2 (n = 935 patients, 15.6% had outcome), the algorithm that obtained the highest sensitivity (97.8%; 95% CI: 96.0–98.9 and 98.6%; 95% CI: 95.1–99.8, respectively) in both cohorts was COMPASS-MI. Only Cohort-2 with both the ESC and COMPASS-MI algorithms exceeded the specificity benchmark (97.0%; 95% CI: 95.5–98.0 and 96.7%; 95% CI: 95.2–97.8, respectively). Patient selection for serial hsTnI testing will affect specificity estimates, with no algorithm achieving a sensitivity ≥ 99% for 30-day MI or death.

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