Clinical performance of 0/1 h cardiac troponin algorithm for diagnosing non-STEMI in an emergency setting

Am J Emerg Med. 2023 Sep:71:139-143. doi: 10.1016/j.ajem.2023.06.036. Epub 2023 Jun 24.

Abstract

Background: Non-ST-segment elevation myocardial infarction (NSTEMI) is a common form of acute myocardial infarction and rapid and accurate diagnosis is crucial for timely treatment. Current guidelines recommend using high-sensitivity cardiac troponin (hs-cTn) assays to determine circulating cTnI or cTnT levels. While the accuracy of the 0 h/1 h algorithm for diagnosing NSTEMI in different regions and patient populations remains controversial. Additionally, point-of-care testing (POCT) cTn assays have the potential to provide troponin readings to physicians within 15 min, but their accuracy in diagnosing NSTEMI in the emergency department (ED) requires further investigation.

Methods: A single-center prospective observational cohort study was conducted at Shaanxi Provincial People's Hospital to assess the analytical and diagnostic performance of the laboratory-based Roche Modular E170 hs-cTnT using the 0 h/1 h algorithm with Radiometer AQT90-flex POCT cTnT assay in undifferentiated chest pain patients presenting to the ED. Whole-blood samples were collected and hs-cTnT and POCT cTnI were measured simultaneously at baseline and after 1 h.

Results: The study results showed that the POCT cTnT assay using the 0 h/1 h algorithm had comparable diagnostic accuracy to the laboratory-based Roche Modular E170 hs-cTnT assay in diagnosing NSTEMI in patients with chest pain.

Conclusion: The laboratory-based Roche Modular E170 hs-cTnT using the 0 h/1 h algorithm is reliable and accurate method for diagnosing NSTEMI in undifferentiated chest pain patients presenting to the ED. POCT cTnT assay has comparable diagnostic accuracy to the hs-cTnT assay and its rapid turnaround time makes it a valuable tool in expediting the diagnostic workup of chest pain patients.

Keywords: Diagnostic accuracy; High-sensitivity cardiac troponin (hs-cTn) 0 h/1 h algorithm; Non-ST-segment elevation myocardial infarction (NSTEMI); Point-of-care testing (POCT) cTn assays.

Publication types

  • Observational Study

MeSH terms

  • Algorithms
  • Biomarkers
  • Chest Pain / diagnosis
  • Chest Pain / etiology
  • Emergency Service, Hospital
  • Humans
  • Non-ST Elevated Myocardial Infarction* / diagnosis
  • Prospective Studies
  • ST Elevation Myocardial Infarction*
  • Troponin I
  • Troponin T

Substances

  • Troponin T
  • Troponin I
  • Biomarkers