What is it about?
The aim of this study was to provide a methodology to verify whether the information given by the 0/3h protocol of the high sensitivity cardiac Troponin T test was satisfactory in the detection or exclusion of Acute Myocardial Infarction in the real-world setting of our Emergency Department, including those situations in which impaired kidney function could have complicated the interpretation of cTn results. In addition, the study evaluated whether the application of sex-specific cutoffs could have improved the diagnostic accuracy for Acute Coronary Syndrome.
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Why is it important?
High sensitivity Cardiac Troponin values exceeding the 99th percentile of a healthy reference population with an increase/decrease pattern are only indicative of acute myocardial damage. To identify Acute Myocardial Infarction (AMI), it is necessary to evaluate 2 other factors: whether there is a specific kinetics of variation (delta change), typical of Acute Coronary Syndromes (ACS), and whether there is an ischemic condition that can be detected by symptomatology or other tests, such as electrocardiogram or imaging. The debate on decision-making limits is always topical, and numerous studies are underway to assess the clinical utility of sex- or age-differentiated cutoffs. Furthermore, there is no “universal” delta; even a small variation (>20%) can be significant in the appropriate clinical context. Therefore, in the present study we aimed to provide a practical methodology for the evaluation of decision limits for ACS diagnosis in a “real-world” population. The population sample under examination included all possible cases of patients presenting in the Emergency Department with suspected ACS, regardless of their comorbidities, as happens in real life. This study provides a simple methodology by which each organization can evaluate the performance of their decision limits. Our findings show that the application of sex-specific cutoffs does not seem to improve accuracy and confirm that the thresholds adopted by the University Hospital of Siena have the best possible accuracy regarding the hs-cTnT algorithm for the diagnosis of AMI.
Perspectives
The differential diagnosis of acute chest pain is one of the most complex challenges in emergency departments (ED) because acute coronary syndrome (ACS) is associated with high mortality and morbidity. The analysis of the results of diagnostic assays, correlated to the actual diagnoses issued, can be very useful to optimize the predictive capacity of the high sensitivity cardiac troponin T test: even small changes made to such a protocol can lead to benefits on waiting times and reduction of ED overcrowding, with considerable savings in health care spending.
Dr. Claudia Bellini
University Hospital of Siena
Read the Original
This page is a summary of: Methodology to Evaluate Clinical Impact of 0/3 Hour High-Sensitivity Cardiac Troponin T Protocol on Managing Acute Coronary Syndrome in Daily Emergency Department Practice, Laboratory Medicine, January 2021, Oxford University Press (OUP),
DOI: 10.1093/labmed/lmaa118.
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