High-sensitivity-cardiac troponin for accelerated diagnosis of acute myocardial infarction: A systematic review and meta-analysis.
Am J Emerg Med
; 38(7): 1402-1407, 2020 07.
Article
in En
| MEDLINE
| ID: mdl-31932131
ABSTRACT
OBJECTIVES:
Cardiovascular disease is the leading cause of mortality and morbidity. Serial troponin tests have been endorsed as essential diagnostic steps to rule out/-in acute myocardial infarction (AMI), and hs-cTn assays have shown promise in enhancing the accuracy and efficiency of AMI diagnosis in the emergency department (ED).METHODS:
A systematic review and meta-analysis of diagnostic test accuracy studies were conducted to compare the diagnostic performance of various accelerated diagnostic algorithms of hs-cTn assays for patients with symptoms of AMI. Random-effects bivariate meta-analysis was conducted to estimate the summary sensitivity, specificity, likelihood ratios, and area under receiver operating characteristic curve.RESULTS:
In the systematic review consisting of 56 studies and 67,945 patients, both hs-cTnT and hs-cTnI-based 0-, 1-, 2- and 0-1â¯h algorithms showed a pooled sensitivity >90%. The hs-cTnI-based algorithm showed a pooled specificity >80%. The hs-cTnT-based algorithms had a specificity of 68% for the 0-h algorithm and of around 80% for the 1-, 2-, and 0-1â¯h algorithms. The heterogeneities of all diagnostic algorithms were mild (I2â¯<â¯50%).CONCLUSION:
Both hs-cTnI- and hs-cTnT-based accelerated diagnostic algorithms have high sensitivities but moderate specificities for early diagnosis of AMI. Overall, hs-cTnI-based algorithms have slightly higher specificities in early diagnosis of AMI. For patients presenting ED with typical symptoms, the use of hs-cTnT or hs-cTnI assays at the 99th percentile may help identify patients with low risk for AMI and promote early discharge from the ED.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Troponin I
/
Troponin T
/
Myocardial Infarction
Type of study:
Diagnostic_studies
/
Prognostic_studies
/
Screening_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Am J Emerg Med
Year:
2020
Type:
Article