Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an Emergency Department: A clinical cohort study

Diagnostic performance of a high-sensitive troponin T assay and a troponin T point of care assay in the clinical routine of an Emergency Department: A clinical cohort study. Slagman, A., von Recum, J., Möckel, M., Holert, F., Meyer zum Büschenfelde, D., Müller, C., & Searle, J. International Journal of Cardiology, 230:454–460, March, 2017.

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Background: A point of care test (POCT) for troponin T (TnT) in the Emergency Department (ED) was compared to a high-sensitivity TnT (hsTnT) central laboratory test (CLT) to determine the inﬂuence of test system and different cut-off values on the diagnostic performance in patients with suspected acute coronary syndrome (ACS) under routine conditions. Methods: All patients with routine TnT testing in the ED were enrolled. Only internal medicine patients without STEMI and with both troponin values were analyzed. TnT was measured with a contemporary sensitive POCT assay in the ED and with a hs-assay in the central laboratory. The diagnostic performance was analyzed at two different cut-off points (99th percentile and conventional rule-in cut-offs). Primary endpoint was the diagnosis of NSTEMI. Results: Of all patients (n = 3423), 3.6% had a diagnosis of NSTEMI (n = 124). For the hsTnT assay, 28.4% of all values were at or below the lower limit of detection (LOD) as compared to 75.7% of the POC-TnT-values. The area under the receiver operating curves did not differ signiﬁcantly between the assays (hsTnT: 0.912(95%-CI: 0.884–0.940); POC-TnT: 0.896(95%-CI: 0.859–0.933)). The diagnostic performance was very similar for both assays: the positive predictive value was below 50% for troponin values below 100 ng/L and hardly increased for values between 100 and 600 ng/L for hs and conventional assays. Conclusions: In our cohort of emergency patients, the diagnostic performance of conventional POC-testing was comparable to hsTnT. A 99th percentile cut-off may be useful for rule-out of NSTEMI, but seems limited for routine rule-in strategies.

@article{slagman_diagnostic_2017,
	title = {Diagnostic performance of a high-sensitive troponin {T} assay and a troponin {T} point of care assay in the clinical routine of an {Emergency} {Department}: {A} clinical cohort study},
	volume = {230},
	issn = {01675273},
	shorttitle = {Diagnostic performance of a high-sensitive troponin {T} assay and a troponin {T} point of care assay in the clinical routine of an {Emergency} {Department}},
	url = {http://linkinghub.elsevier.com/retrieve/pii/S0167527316345764},
	doi = {10.1016/j.ijcard.2016.12.085},
	abstract = {Background: A point of care test (POCT) for troponin T (TnT) in the Emergency Department (ED) was compared to a high-sensitivity TnT (hsTnT) central laboratory test (CLT) to determine the inﬂuence of test system and different cut-off values on the diagnostic performance in patients with suspected acute coronary syndrome (ACS) under routine conditions.
Methods: All patients with routine TnT testing in the ED were enrolled. Only internal medicine patients without STEMI and with both troponin values were analyzed. TnT was measured with a contemporary sensitive POCT assay in the ED and with a hs-assay in the central laboratory. The diagnostic performance was analyzed at two different cut-off points (99th percentile and conventional rule-in cut-offs). Primary endpoint was the diagnosis of NSTEMI.
Results: Of all patients (n = 3423), 3.6\% had a diagnosis of NSTEMI (n = 124). For the hsTnT assay, 28.4\% of all values were at or below the lower limit of detection (LOD) as compared to 75.7\% of the POC-TnT-values. The area under the receiver operating curves did not differ signiﬁcantly between the assays (hsTnT: 0.912(95\%-CI: 0.884–0.940); POC-TnT: 0.896(95\%-CI: 0.859–0.933)). The diagnostic performance was very similar for both assays: the positive predictive value was below 50\% for troponin values below 100 ng/L and hardly increased for values between 100 and 600 ng/L for hs and conventional assays.
Conclusions: In our cohort of emergency patients, the diagnostic performance of conventional POC-testing was comparable to hsTnT. A 99th percentile cut-off may be useful for rule-out of NSTEMI, but seems limited for routine rule-in strategies.},
	language = {en},
	urldate = {2018-03-17TZ},
	journal = {International Journal of Cardiology},
	author = {Slagman, Anna and von Recum, Johannes and Möckel, Martin and Holert, Fabian and Meyer zum Büschenfelde, Dirk and Müller, Christian and Searle, Julia},
	month = mar,
	year = {2017},
	keywords = {\_tablet},
	pages = {454--460}
}

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Methods: All patients with routine TnT testing in the ED were enrolled. Only internal medicine patients without STEMI and with both troponin values were analyzed. TnT was measured with a contemporary sensitive POCT assay in the ED and with a hs-assay in the central laboratory. The diagnostic performance was analyzed at two different cut-off points (99th percentile and conventional rule-in cut-offs). Primary endpoint was the diagnosis of NSTEMI. Results: Of all patients (n = 3423), 3.6% had a diagnosis of NSTEMI (n = 124). For the hsTnT assay, 28.4% of all values were at or below the lower limit of detection (LOD) as compared to 75.7% of the POC-TnT-values. The area under the receiver operating curves did not differ signiﬁcantly between the assays (hsTnT: 0.912(95%-CI: 0.884–0.940); POC-TnT: 0.896(95%-CI: 0.859–0.933)). The diagnostic performance was very similar for both assays: the positive predictive value was below 50% for troponin values below 100 ng/L and hardly increased for values between 100 and 600 ng/L for hs and conventional assays. Conclusions: In our cohort of emergency patients, the diagnostic performance of conventional POC-testing was comparable to hsTnT. 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Only internal medicine patients without STEMI and with both troponin values were analyzed. TnT was measured with a contemporary sensitive POCT assay in the ED and with a hs-assay in the central laboratory. The diagnostic performance was analyzed at two different cut-off points (99th percentile and conventional rule-in cut-offs). Primary endpoint was the diagnosis of NSTEMI.\nResults: Of all patients (n = 3423), 3.6\\% had a diagnosis of NSTEMI (n = 124). For the hsTnT assay, 28.4\\% of all values were at or below the lower limit of detection (LOD) as compared to 75.7\\% of the POC-TnT-values. The area under the receiver operating curves did not differ signiﬁcantly between the assays (hsTnT: 0.912(95\\%-CI: 0.884–0.940); POC-TnT: 0.896(95\\%-CI: 0.859–0.933)). 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