Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction

被引:28
|
作者
Aldous, Sally [1 ]
Richards, A. Mark [2 ,3 ,4 ]
George, Peter M. [5 ]
Cullen, Louise [6 ]
Parsonage, William A. [6 ]
Flaws, Dylan [7 ]
Florkowski, Christopher M. [5 ]
Troughton, Richard W. [2 ,3 ]
O'Sullivan, Jack W. [6 ]
Reid, Christopher M. [8 ]
Bannister, Laura [2 ]
Than, Martin [2 ]
机构
[1] Christchurch Hosp, Dept Cardiol, Christchurch, New Zealand
[2] Christchurch Hosp, Christchurch, New Zealand
[3] Univ Otago, Christchurch, New Zealand
[4] Natl Univ Singapore, Ctr Heart, Singapore 117548, Singapore
[5] Canterbury Hlth Labs, Christchurch, New Zealand
[6] Royal Brisbane & Womens Hosp, Brisbane, Qld, Australia
[7] Univ Technol, Brisbane, Qld, Australia
[8] Monash Univ, Melbourne, Vic 3004, Australia
关键词
High sensitivity troponin; Point of care troponin; Acute myocardial infarction; Major adverse cardiac events; Accelerated diagnostic protocol; ACUTE CORONARY SYNDROME; EMERGENCY-DEPARTMENT PATIENTS; CHEST-PAIN SYMPTOMS; CARDIAC TROPONIN; RANDOMIZED ASSESSMENT; RISK STRATIFICATION; PANEL ASSAY; MARKERS; PROTOCOL; DEFINITIONS;
D O I
10.1016/j.ijcard.2014.09.026
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: The aim of this study is to compare a new improved point of care cardiac troponin assay (new POC-cTnI) with 1. its predecessor (old POC-cTnI) and 2. a high sensitivity assay (hs-cTnI) for the diagnosis of acute myocardial infarction (AMI) and for major adverse cardiac events (MACE) by 30 days. Methods: This is a single centre observational study, set in Christchurch Hospital, NewZealand. Patients presenting to the emergency department with non-traumatic chest pain underwent blood sampling at 0 h and 2 h post presentation for analysis with the 3 cTnI assays for the outcome of AMI and for analysis using an accelerated diagnostic protocol (ADP-normal 2 h troponins, normal electrocardiograms and Thrombolysis In Myocardial Infarction (TIMI) score of 0 or <= 1) for 30 day MACE. Results: Of 962 patients, 220 (22.9%) had AMI. Old POC-cTnI was least sensitive at 70.0% (65.4-73.9%) by 2 h (p < 0.001). New POC-cTnI, sensitivity 93.6% (89.9-96.2%) had similar sensitivity to hs-cTnI, sensitivity 95.0% (91.5-97.3%) (p = 0.508). There were 231 (24.0%) patients with 30 day MACE. When used as part of the ADP, all assays had 100% (98.0-100%) sensitivity using TIMI = 0. Sensitivities of new POC-cTnI ADP, 98.3% (95.4-99.4%), old POC-cTnI, 96.5% (93.2-98.4%) and hs-cTnI, 98.7% (96.0-99.7%) were similar (p = 0.063-0.375) using TIMI <= 1. Conclusions: A new POC-cTnI has improved sensitivity for AMI andMACE compared with its predecessor and comparable sensitivity to a high sensitivity assay. Now that sensitivities of the POC assay are improved, the new assay may be a useful alternative to central laboratory assays when rapid turn-around times are not possible. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:182 / 186
页数:5
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