Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

Aims: The purpose of this study was to determine (a) the ability of serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and (b) the ability of a single high baseline high-sensitivity cardiac troponin T measurement to rule in acute myocardial infarction in patients presenting to the emergency department with acute chest pain. Methods and results: Embase, Medline, Cochrane, Web of Science and Google scholar were searched for prospective cohort studies that evaluated parameters of diagnostic accuracy of serial high-sensitivity cardiac troponin T to rule out acute myocardial infarction and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction. The search yielded 21 studies for the systematic review, of which 14 were included in the meta-analysis, with a total of 11,929 patients and an overall prevalence of acute myocardial infarction of 13.0%. For rule-out, six studies presented the sensitivity of serial measurements <14 ng/l. This cut-off classified 60.1% of patients as rule-out and the summary sensitivity was 96.7% (95% confidence interval: 92.3–99.3). Three studies presented the sensitivity of a one-hour algorithm with a baseline high-sensitivity cardiac troponin T value<12 ng/l and delta 1 hour <3 ng/l. This algorithm classified 60.2% of patients as rule-out and the summary sensitivity was 98.9% (96.4–100). For rule-in, six studies reported the specificity of baseline high-sensitivity cardiac troponin T value>50 ng/l. The summary specificity was 94.6% (91.5–97.1). Conclusion: Serial high-sensitivity cardiac troponin T measurement strategies to rule out acute myocardial infarction perform well, and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction has a high specificity.

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SERIAL HIGH-SENSITIVITY CARDIAC TROPONIN T MEASUREMENTS TO RULE OUT ACUTE MYOCARDIAL INFARCTION AND A SINGLE HIGH BASELINE MEASUREMENT FOR SWIFT RULE-IN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)30890-3 ◽

2019 ◽

Vol 73 (9) ◽

pp. 282 ◽

Cited By ~ 1

Author(s):

Murat Arslan ◽

Admir Dedic ◽

Eric Boersma ◽

Eric A. Dubois

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

Acute Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin T ◽

Meta Analysis ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Baseline Measurement ◽

Rule Out

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P2678Performance of the European society cardiology 0/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T: meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0996 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L M Burgos ◽

L Battioni ◽

J P Costabel ◽

M Trivi

Keyword(s):

Myocardial Infarction ◽

Systematic Review ◽

European Society ◽

Cardiac Troponin ◽

Troponin T ◽

Meta Analysis ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Cumulative Mortality ◽

Rule Out

Abstract Introduction A rapid rule-out or rule-in protocol based on the 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC), and recently multiple studies have validated it in their settings. We conducted a systematic review and meta-analysis with the aim of assess the diagnostic accuracy of the 2015 ESC guidelines for management of acute coronary syndrome (ACS) in patients without ST-segment elevation's 0-/1-hour algorithm using hs-cTnT for the early rule-out and rule-in of acute myocardial infarction (AMI) on presentation. For the secondary analysis we evaluate cumulative mortality at 30 days. Methods We carried out a systematic review and meta-analysis of prospective studies involving adults presenting to the emergency department with possible ACS in which hs-cTnT measurements were obtained according to the ESC algorithm and AMI outcomes were adjudicated during the initial hospitalization. We searched MEDLINE, EMBASE, Cochrane database and LILACS, and unpublished abstracts presented in international congresses from 2015 to November 2018.To obtain estimates of sensitivity and specificity, with corresponding 95% confidence intervals (CI), we used a bivariable random-effects model. Summary receiver operating characteristic curves were drawn, plotting individual studies as well as the summary estimate. Results Seven studies involving 9251 patients were identified. The summary sensitivity of these tests in diagnosing acute MI at presentation to the emergency department was estimated to be 99.1% (95% CI 97.2–99.7%) and the summary specificity was 92.5% (95% CI 86.6–95.9%). With a false positive rate of 0.075 (95% CI 0.041–0.134), diagnostic odds ratio (DOR) of 1293.1 (95% CI −52.48 to 2638.5), and Likelihood Ratio (LR) +13.193 (95% CI 5.3–21, and LR −0.010 (95% CI −0.001 to 0.021). Cumulative mortality at 30 days in the rule-out group was 0,08% (4 studies; n=3715). Conclusion The European Society Cardiology 0-Hour/1-Hour Algorithm using High-Sensitivity Cardiac Troponin T has high diagnostic accuracy, it allows safe rule-out as well as accurate rule-in of acute myocardial infarction. With low cumulative 30-day mortality in patients assigned the rule-out zone.

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