Accelerated diagnostic pathways for myocardial infarction using a Siemens High-Sensitivity cardiac troponin I assay

被引:0
作者
Azuma, Hiroyuki [1 ]
Tada, Masafumi [2 ]
Matano, Hideyuki [3 ]
Yamada, Naoki [4 ]
Uzui, Hiroyasu [5 ]
Maeno, Koji [6 ]
Shimada, Yoshimitsu [7 ]
Yoshida, Hiroyuki [8 ]
Murahashi, Hajime [9 ]
Ando, Masaki [10 ]
Hachiya, Kenta [11 ]
Tanaka, Shun [12 ]
Hattori, Tomonori [13 ]
Kuriyama, Akira [14 ]
Fujisawa, Takeshi [15 ]
Chapman, Andrew R. [15 ]
Mills, Nicholas L. [15 ,16 ]
Hayashi, Hiroyuki [4 ]
Watanabe, Norio [17 ]
Furukawa, Toshi A. [18 ]
机构
[1] Fukui Prefectural Hosp, Dept Emergency Med, Fukui, Japan
[2] Nagoya City Univ East Med Ctr, Dept Clin Res Management Ctr, Emergency Med, Neurol, Nagoya, Aichi, Japan
[3] Fukui Ken Saiseikai Hosp, Dept Emergency Med, Fukui, Japan
[4] Univ Fukui, Dept Emergency Med, Fukui, Japan
[5] Univ Fukui, Dept Cardiovasc Med, Fukui, Japan
[6] Fukui Ken Saiseikai Hosp, Dept Cardiol, Fukui, Japan
[7] Japanese Red Cross Fukui Hosp, Dept Emergency Med, Fukui, Japan
[8] Japanese Red Cross Fukui Hosp, Dept Cardiol, Fukui, Japan
[9] Japanese Red Cross Aichi Med Ctr, Nagoya Daini Hosp, Dept Anaesthesiol & Crit Care, Nagoya, Aichi, Japan
[10] Kariya Toyota Gen Hosp, Dept Emergency & Crit Care Med, Kariya, Aichi, Japan
[11] Nagoya City Univ East Med Ctr, Dept Cardiol, Nagoya, Aichi, Japan
[12] Univ Tsukuba Hosp, Dept Stroke & Cerebrovascular Dis, Ibaraki, Japan
[13] Nagoya City Univ, Grad Sch Med Sci, Dept Emergency Med & Crit Care, Nagoya, Aichi, Japan
[14] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
[15] Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Scotland
[16] Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Edinburgh, Scotland
[17] Soseikai Gen Hosp, Dept Psychiat, Kyoto, Japan
[18] Kyoto Univ, Sch Publ Hlth, Grad Sch Med, Off Inst Adv & Commun, Kyoto, Japan
关键词
Myocardial infarction; High sensitivity troponin; Diagnostic pathway; CHEST-PAIN; PROSPECTIVE VALIDATION; RULE-OUT; ASSOCIATION; PERFORMANCE;
D O I
10.1016/j.clinbiochem.2025.110897
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
Background: Few studies have comprehensively examined high-sensitivity cardiac troponin I (hs-cTnI) based diagnostic pathways for myocardial infarction (MI) in early presenters using a Siemens ADVIA Centaur hs-cTnI assay. Methods: We conducted a prospective multicenter cohort study in Emergency Departments involving 414 patients suspected of MI within 6 h of symptom onset. We evaluated three hs-cTnI-based pathways (High-STEACS, ESC 0/ 1-h, 0/2-h); and four pathways incorporating medical history and physical findings (ADAPT, EDACS, HEART, GRACE). We evaluated negative predictive value (NPV) and sensitivity as safety measures, and percentage ruled out as an efficiency measure for a primary outcome of type 1 myocardial infarction or cardiac death within 30 days. Results: Median age was 72 years (interquartile range 58-82), and 30.4 % (126/414) of patients were over 80. Females comprised 44.2 % (183/414) of patients, 87.7 % (363/414) had chest pain, and the primary outcome occurred in 9.2 % (38/414). The High-STEACS pathway ruled out 62.0 % of patients without missing a case of an MI. The ESC 0/1-h and 0/2-h pathways showed high NPV and sensitivities; however, they ruled out fewer patients (35.9 % and 45.2 %, respectively). The ADAPT, EDACS, and HEART pathways demonstrated high NPV and sensitivities but ruled out fewer patients (15-27 %). The GRACE pathway missed 2 cases with primary clinical outcomes. Among patients over 80 without MI, initial hs-cTnI concentration was >= 3 ng/L in 99.1 % and >= 5 ng/ L in 84.1 %. Conclusions: The High-STEACS pathway was the most efficient among the hs-cTnI-based pathways while maintaining excellent safety performance in early presenters.
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页数:9
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