{"id":732,"date":"2019-07-21T09:44:00","date_gmt":"2019-07-21T09:44:00","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=732"},"modified":"2021-01-29T11:18:01","modified_gmt":"2021-01-29T11:18:01","slug":"diagnostic-accuracy-of-a-high-sensitivity-cardiac-troponin-assay-with-a-single-serum-test-in-the-emergency-department","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=732","title":{"rendered":"Novel hs-cTn Assay with a Single Serum Test in ED."},"content":{"rendered":"\n<figure data-carousel-extra='{\"blog_id\":1,\"permalink\":\"http:\\\/\\\/clinicalbiochemistry.net\\\/?page_id=732\"}'  class=\"wp-container-2 wp-block-gallery-1 wp-block-gallery alignleft columns-1 is-cropped\"><ul class=\"blocks-gallery-grid\"><li class=\"blocks-gallery-item\"><figure><img data-attachment-id=\"681\" data-permalink=\"http:\/\/clinicalbiochemistry.net\/?attachment_id=681\" data-orig-file=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/02\/iStock-530199842.jpg?fit=638%2C547\" data-orig-size=\"638,547\" data-comments-opened=\"0\" data-image-meta=\"{&quot;aperture&quot;:&quot;0&quot;,&quot;credit&quot;:&quot;Getty Images\\\/iStockphoto&quot;,&quot;camera&quot;:&quot;&quot;,&quot;caption&quot;:&quot;3D illustration of Heart - Part of Human Organic.&quot;,&quot;created_timestamp&quot;:&quot;0&quot;,&quot;copyright&quot;:&quot;yodiyim&quot;,&quot;focal_length&quot;:&quot;0&quot;,&quot;iso&quot;:&quot;0&quot;,&quot;shutter_speed&quot;:&quot;0&quot;,&quot;title&quot;:&quot;3D illustration of Heart, medical concept.&quot;,&quot;orientation&quot;:&quot;1&quot;}\" data-image-title=\"3D illustration of Heart, medical concept.\" data-image-description=\"\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/02\/iStock-530199842.jpg?fit=300%2C257\" data-large-file=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/02\/iStock-530199842.jpg?fit=638%2C547\" loading=\"lazy\" width=\"638\" height=\"547\" src=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/02\/iStock-530199842.jpg?resize=638%2C547\" alt=\"\" data-id=\"681\" data-link=\"http:\/\/clinicalbiochemistry.net\/?attachment_id=681\" class=\"wp-image-681\" srcset=\"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/02\/iStock-530199842.jpg?w=638 638w, https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/02\/iStock-530199842.jpg?resize=300%2C257 300w\" sizes=\"(max-width: 638px) 100vw, 638px\" data-recalc-dims=\"1\" \/><figcaption class=\"blocks-gallery-item__caption\">3D illustration of Heart &#8211; Part of Human Organic.<\/figcaption><\/figure><\/li><\/ul><\/figure>\n\n\n\n<h3>Objectives<\/h3>\n\n\n\n<p>To evaluate diagnostic accuracy of a high-sensitivity cardiac troponin I (hs-cTnI) assay for acute coronary syndromes (ACS) in the Emergency Department (ED). The assay has high precision at low concentrations and can detect cTnI in 96.8% of healthy individuals.&nbsp;<\/p>\n\n\n\n<h3>Methods<\/h3>\n\n\n\n<p>In successive prospective multi-center studies (\u2018testing\u2019 and \u2018validation\u2019) we included ED patients with suspected ACS. We drew blood for hs-cTnI (Singulex Clarity\u00ae cTnl, 99th percentile 8.67ng\/L, limit of detection [LoD] 0.08ng\/L) on arrival. Patients also underwent hs-cTnT (Roche Elecsys) testing over \u22653h. The primary outcome was an adjudicated diagnosis of ACS, defined as acute myocardial infarction (AMI; prevalent or incident), death, or revascularization within 30 days.<\/p>\n\n\n\n<h3>Results<\/h3>\n\n\n\n<p>The testing and validation studies included 665 and 2,470 patients respectively, of which 94 (14.1%) and&nbsp;565 (22.9%)&nbsp;&nbsp;had ACS. At a 1.5ng\/L cut-off, hs-cTnI had good sensitivity for AMI in both studies (98.7% and 98.1% respecively) and would have \u2018ruled out\u2019 40.1% and 48.9% patients. However, sensitivity was lower for ACS (95.7% and 90.6% respectively). At a 0.8ng\/L cut-off sensitivity for ACS was higher (97.5% and 97.9%, \u2018ruling out\u2019 28.6% patients in each cohort). The hs-cTnT assay had very similar performance at the LoD (24.6% \u2018ruled out\u2019, 97.2% sensitivity for ACS).<\/p>\n\n\n\n<h3>Conclusion&nbsp;<\/h3>\n\n\n\n<p>The hs-cTnI assay could immediately \u2018rule out\u2019 AMI in 40% patients and ACS in over 25%, with similar accuracy to hs-cTnT at the LoD. Because of its high precision at low concentrations, this hs-cTnI assay has favourable characteristics for this clinical application.<\/p>\n\n\n\n\n<a class=\"maxbutton-27 maxbutton maxbutton-singulex-troponin\" target=\"_blank\" title=\"Link to Publisher\" rel=\"noopener\" href=\"http:\/\/clinchem.aaccjnls.org\/content\/early\/2019\/04\/30\/clinchem.2018.294272.long\"><span class='mb-text'>Link to Publisher<\/span><\/a>","protected":false},"excerpt":{"rendered":"<p>Objectives To evaluate diagnostic accuracy of a high-sensitivity cardiac troponin I (hs-cTnI) assay for acute coronary syndromes (ACS) in the Emergency Department (ED). The assay has high precision at low concentrations and can detect cTnI in 96.8% of healthy individuals.&nbsp;<\/p>\n","protected":false},"author":1,"featured_media":739,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-bO","jetpack-related-posts":[{"id":646,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=646","url_meta":{"origin":732,"position":0},"title":"Undetectable hs-cTnT","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G., Jaffe, A.S., France, M., Cruickshank, K., Wibberley, C., Nuttall, M. & Mackway-Jones, K. (2011) \u2018Rapid exclusion of acute myocardial infarction in patients\u2019 with undetectable troponin using a high sensitivity assay.\u2019\u00a0J Am Coll Cardiol58 pp. 1332-1339. Objectives:This paper sought to evaluate whether high sensitivity troponin (hs-cTnT)\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/JACC-paper-e1549807840111.png?fit=400%2C268&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":568,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=568","url_meta":{"origin":732,"position":1},"title":"T-MACS and POCT Troponin","date":"January 17, 2019","format":false,"excerpt":"The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid for rapid rule-in and rule-out of acute coronary syndromes using a contemporary point of care troponin assay Richard Body; Malak Almashali; Niall Morris; Phil Moss; Heather Jarman; Andrew Appelboam; Richard Parris; Louisa Chan; Alison Walker; Mark Harrison; Andrea Wootten; Garry McDowellc\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":732,"position":2},"title":"PhD Project: BEST Study","date":"January 11, 2019","format":false,"excerpt":"Expediting the confirmation of acute myocardial infarction with point of care troponin and heart fatty acid binding protein testing to facilitate early intervention in emergency department Cardiac troponin is the reference standard biomarker for the diagnosis of acute myocardial infarction (AMI). In the appropriate clinical context, the detection of a\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":259,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=259","url_meta":{"origin":732,"position":3},"title":"Inter-Observer Variability of H-FABP","date":"December 31, 2017","format":false,"excerpt":"Mashali, M., Norris, N., McDowell, G. & Body, R. (2016) The inter-observer reliability of a novel qualitative point of care assay for heart-type fatty acid binding protein. Clin Biochem 49 pp. 1199-1201 \u00a0 Background Heart-type fatty acid\u2013binding protein (h-FABP) may help to improve the early diagnosis of acute coronary syndromes\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages-1-300x200.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":121,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=121","url_meta":{"origin":732,"position":4},"title":"Research Papers","date":"December 22, 2017","format":false,"excerpt":"Body, R., McDowell, G., Carley, S., Ferguson, J. & Mackway-Jones, K. (2010) \u2018Diagnosing acute myocardial infarction with troponins: how low can you go?\u2019 Emerg Med J. 27 pp. 292-296. Body, R., Carley, S., Wibberley, C., McDowell, G., Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":499,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=499","url_meta":{"origin":732,"position":5},"title":"Acetlycholine &#038; Monomeric C-Reactive Protein","date":"January 1, 2019","format":false,"excerpt":"Slevin, M., Lemma, R.S., Zeinolabediny, Y., Liu, D., Ferris, G.R., Caprio, V., Phillips, N., Di Napoli, M., Guo, B., Zeng, X., AlBaradie, R., Binsaleh, N.K.,\u00a0McDowell, G. & Fang, W-H. (2018) Acetylcholine inhibits monomeric C-Reactive Protein inducd inflammation, endothelial cell adhesion and platelet aggregation; A potential therapeutic. Frontiers in Immunology 9\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Lab-Equipment-Pages.png?fit=800%2C534&resize=350%2C200","width":350,"height":200},"classes":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/732"}],"collection":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=732"}],"version-history":[{"count":8,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/732\/revisions"}],"predecessor-version":[{"id":827,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/732\/revisions\/827"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/media\/739"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=732"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}