Optimizing the Use of High-Sensitivity Troponin Assays for the Early Rule-out of Myocardial Infarction in Patients Presenting with Chest Pain: A Systematic Review
| Autor: | Nigel Armstrong, Sabine Grimm, Debra Fayter, Bram Ramaekers, Janine Ross, Titas Buksnys, Richard Body, Adam Timmis, Paul Collinson, Marie Westwood, Gill Worthy, Jos Kleijnen, Nicholas L. Mills |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty diagnosis Clinical Biochemistry I ASSAYS 030204 cardiovascular system & hematology Chest pain Logistic regression Sensitivity and Specificity Angina Pectoris Single test 03 medical and health sciences 0302 clinical medicine Troponin T Internal medicine medicine Acute chest pain Humans In patient 030212 general & internal medicine Myocardial infarction Non-ST Elevated Myocardial Infarction METAANALYSIS Randomized Controlled Trials as Topic Diagnostic Tests Routine business.industry american-college Troponin I Biochemistry (medical) association point medicine.disease Confidence interval High sensitivity troponin Cardiology medicine.symptom business Algorithms |
| Zdroj: | Clinical Chemistry. 67:237-244 |
| ISSN: | 1530-8561 0009-9147 |
| DOI: | 10.1093/clinchem/hvaa280 |
| Popis: | Background We assessed the accuracy and clinical effectiveness of high-sensitivity cardiac troponin (hs-cTn) assays for early rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) in adults presenting with acute chest pain. Methods Sixteen databases were searched to September 2019. Review methods followed published guidelines. The bivariate model was used to estimate summary sensitivity and specificity with 95% confidence intervals for meta-analyses involving 4 or more studies, otherwise random-effects logistic regression was used. Results Thirty-seven studies (124 publications) were included in the review. The hs-cTn test strategies evaluated in the included studies were defined by the combination of 4 factors (assay, number of tests, timing of tests, and threshold concentration or change in concentration between tests). Clinical opinion indicated a minimum acceptable sensitivity of 97%. A single test at presentation using a threshold at or near the assay limit of detection could reliably rule-out NSTEMI for a range of hs-cTn assays. Serial testing strategies, which include an immediate rule-out step, increased the proportion ruled out without loss of sensitivity. Finally, serial testing strategies without an immediate rule-out step had excellent sensitivity and specificity, but at the expense of the option for immediate patient discharge. Conclusion Test strategies that comprise an initial rule-out step, based on low hs-cTn concentrations at presentation and a minimum symptom duration, and a second step for those not ruled-out that incorporates a small absolute change in hs-cTn at 1, 2, or 3 hours, produce the highest rule-out rates with a very low risk of missed NSTEMI. PROSPERO registration CRD42019154716 |
| Databáze: | OpenAIRE |
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