Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction

Results of a prospective multicenter trial

Alan B. Storrow, Robert H. Christenson, Richard M. Nowak, Deborah B. Diercks, Adam J. Singer, Alan H B Wu, Erik Kulstad, Frank LoVecchio, Christian Fromm, Gary Headden, Tracie Potis, Christopher J. Hogan, Jon W. Schrock, Daniel P. Zelinski, Marna R. Greenberg, James C. Ritchie, Janna S. Chamberlin, Kurtis R. Bray, Daniel W. Rhodes, Deirdre Trainor & 2 others Dawn Holmes, Paula C. Southwick

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives: To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. Methods: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent ischemic symptoms suggestive of acute coronary syndromes at 14 medical centers. Diagnosis was adjudicated by an independent central committee. Results: TnI ≥. 0.03. ng/mL provided 96.0% sensitivity and 89.4% specificity at 1-3. h after admission, and 94.9% sensitivity and 86.7% specificity at 3-6. h. NPV (rule-out, non-MI) was 99.5% at 1-3. h, and 99.0% at 3-6. h when TnI is <. 0.03. ng/mL. NPV was 99.1% when TnI is <. 0.03. ng/mL and time of symptom onset is ≥. 8. h. Approximately 50-58% (PPV) of patients with TnI ≥. 0.03. ng/mL were diagnosed with MI, depending upon time from onset or admission; PPVs emphasize the importance of serial samples and delta TnI (rising or falling pattern) when low cutoffs are used. Nevertheless, even a single elevated TnI value increased the risk of MI. As TnI values rose, the probability of MI increased. Values ≥. 0.20. ng/mL were associated with nearly 90% probability of MI. Conclusions: We report a large multicenter prospective adjudicated trial assessing troponin for early rule-in and rule-out using the Universal Definition of MI and conducted in primary care hospital-associated emergency departments. Our study demonstrates high diagnostic accuracy at early observation times, and reinforces consensus recommendations for sampling on admission and 3. h later, repeated at 6. h when clinical suspicion remains high.

Original languageEnglish (US)
Pages (from-to)254-259
Number of pages6
JournalClinical Biochemistry
Volume48
Issue number4-5
DOIs
StatePublished - Mar 1 2015

Fingerprint

Troponin I
Multicenter Studies
Myocardial Infarction
Sampling
Troponin
Hospital Emergency Service
Sensitivity and Specificity
Acute Coronary Syndrome
Chest Pain
Primary Health Care
Observation

Keywords

  • Acute coronary syndromes
  • Biomarkers
  • Chest pain
  • Diagnosis
  • Emergency medicine
  • Myocardial infarction
  • Troponin

ASJC Scopus subject areas

  • Clinical Biochemistry

Cite this

Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction : Results of a prospective multicenter trial. / Storrow, Alan B.; Christenson, Robert H.; Nowak, Richard M.; Diercks, Deborah B.; Singer, Adam J.; Wu, Alan H B; Kulstad, Erik; LoVecchio, Frank; Fromm, Christian; Headden, Gary; Potis, Tracie; Hogan, Christopher J.; Schrock, Jon W.; Zelinski, Daniel P.; Greenberg, Marna R.; Ritchie, James C.; Chamberlin, Janna S.; Bray, Kurtis R.; Rhodes, Daniel W.; Trainor, Deirdre; Holmes, Dawn; Southwick, Paula C.

In: Clinical Biochemistry, Vol. 48, No. 4-5, 01.03.2015, p. 254-259.

Research output: Contribution to journalArticle

Storrow, AB, Christenson, RH, Nowak, RM, Diercks, DB, Singer, AJ, Wu, AHB, Kulstad, E, LoVecchio, F, Fromm, C, Headden, G, Potis, T, Hogan, CJ, Schrock, JW, Zelinski, DP, Greenberg, MR, Ritchie, JC, Chamberlin, JS, Bray, KR, Rhodes, DW, Trainor, D, Holmes, D & Southwick, PC 2015, 'Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial', Clinical Biochemistry, vol. 48, no. 4-5, pp. 254-259. https://doi.org/10.1016/j.clinbiochem.2014.08.018
Storrow, Alan B. ; Christenson, Robert H. ; Nowak, Richard M. ; Diercks, Deborah B. ; Singer, Adam J. ; Wu, Alan H B ; Kulstad, Erik ; LoVecchio, Frank ; Fromm, Christian ; Headden, Gary ; Potis, Tracie ; Hogan, Christopher J. ; Schrock, Jon W. ; Zelinski, Daniel P. ; Greenberg, Marna R. ; Ritchie, James C. ; Chamberlin, Janna S. ; Bray, Kurtis R. ; Rhodes, Daniel W. ; Trainor, Deirdre ; Holmes, Dawn ; Southwick, Paula C. / Diagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction : Results of a prospective multicenter trial. In: Clinical Biochemistry. 2015 ; Vol. 48, No. 4-5. pp. 254-259.
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abstract = "Objectives: To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. Methods: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent ischemic symptoms suggestive of acute coronary syndromes at 14 medical centers. Diagnosis was adjudicated by an independent central committee. Results: TnI ≥. 0.03. ng/mL provided 96.0{\%} sensitivity and 89.4{\%} specificity at 1-3. h after admission, and 94.9{\%} sensitivity and 86.7{\%} specificity at 3-6. h. NPV (rule-out, non-MI) was 99.5{\%} at 1-3. h, and 99.0{\%} at 3-6. h when TnI is <. 0.03. ng/mL. NPV was 99.1{\%} when TnI is <. 0.03. ng/mL and time of symptom onset is ≥. 8. h. Approximately 50-58{\%} (PPV) of patients with TnI ≥. 0.03. ng/mL were diagnosed with MI, depending upon time from onset or admission; PPVs emphasize the importance of serial samples and delta TnI (rising or falling pattern) when low cutoffs are used. Nevertheless, even a single elevated TnI value increased the risk of MI. As TnI values rose, the probability of MI increased. Values ≥. 0.20. ng/mL were associated with nearly 90{\%} probability of MI. Conclusions: We report a large multicenter prospective adjudicated trial assessing troponin for early rule-in and rule-out using the Universal Definition of MI and conducted in primary care hospital-associated emergency departments. Our study demonstrates high diagnostic accuracy at early observation times, and reinforces consensus recommendations for sampling on admission and 3. h later, repeated at 6. h when clinical suspicion remains high.",
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T2 - Results of a prospective multicenter trial

AU - Storrow, Alan B.

AU - Christenson, Robert H.

AU - Nowak, Richard M.

AU - Diercks, Deborah B.

AU - Singer, Adam J.

AU - Wu, Alan H B

AU - Kulstad, Erik

AU - LoVecchio, Frank

AU - Fromm, Christian

AU - Headden, Gary

AU - Potis, Tracie

AU - Hogan, Christopher J.

AU - Schrock, Jon W.

AU - Zelinski, Daniel P.

AU - Greenberg, Marna R.

AU - Ritchie, James C.

AU - Chamberlin, Janna S.

AU - Bray, Kurtis R.

AU - Rhodes, Daniel W.

AU - Trainor, Deirdre

AU - Holmes, Dawn

AU - Southwick, Paula C.

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N2 - Objectives: To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. Methods: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent ischemic symptoms suggestive of acute coronary syndromes at 14 medical centers. Diagnosis was adjudicated by an independent central committee. Results: TnI ≥. 0.03. ng/mL provided 96.0% sensitivity and 89.4% specificity at 1-3. h after admission, and 94.9% sensitivity and 86.7% specificity at 3-6. h. NPV (rule-out, non-MI) was 99.5% at 1-3. h, and 99.0% at 3-6. h when TnI is <. 0.03. ng/mL. NPV was 99.1% when TnI is <. 0.03. ng/mL and time of symptom onset is ≥. 8. h. Approximately 50-58% (PPV) of patients with TnI ≥. 0.03. ng/mL were diagnosed with MI, depending upon time from onset or admission; PPVs emphasize the importance of serial samples and delta TnI (rising or falling pattern) when low cutoffs are used. Nevertheless, even a single elevated TnI value increased the risk of MI. As TnI values rose, the probability of MI increased. Values ≥. 0.20. ng/mL were associated with nearly 90% probability of MI. Conclusions: We report a large multicenter prospective adjudicated trial assessing troponin for early rule-in and rule-out using the Universal Definition of MI and conducted in primary care hospital-associated emergency departments. Our study demonstrates high diagnostic accuracy at early observation times, and reinforces consensus recommendations for sampling on admission and 3. h later, repeated at 6. h when clinical suspicion remains high.

AB - Objectives: To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. Methods: We prospectively measured TnI (AccuTnI+3™, Beckman Coulter) at serial time intervals in 1929 subjects with chest pain or equivalent ischemic symptoms suggestive of acute coronary syndromes at 14 medical centers. Diagnosis was adjudicated by an independent central committee. Results: TnI ≥. 0.03. ng/mL provided 96.0% sensitivity and 89.4% specificity at 1-3. h after admission, and 94.9% sensitivity and 86.7% specificity at 3-6. h. NPV (rule-out, non-MI) was 99.5% at 1-3. h, and 99.0% at 3-6. h when TnI is <. 0.03. ng/mL. NPV was 99.1% when TnI is <. 0.03. ng/mL and time of symptom onset is ≥. 8. h. Approximately 50-58% (PPV) of patients with TnI ≥. 0.03. ng/mL were diagnosed with MI, depending upon time from onset or admission; PPVs emphasize the importance of serial samples and delta TnI (rising or falling pattern) when low cutoffs are used. Nevertheless, even a single elevated TnI value increased the risk of MI. As TnI values rose, the probability of MI increased. Values ≥. 0.20. ng/mL were associated with nearly 90% probability of MI. Conclusions: We report a large multicenter prospective adjudicated trial assessing troponin for early rule-in and rule-out using the Universal Definition of MI and conducted in primary care hospital-associated emergency departments. Our study demonstrates high diagnostic accuracy at early observation times, and reinforces consensus recommendations for sampling on admission and 3. h later, repeated at 6. h when clinical suspicion remains high.

KW - Acute coronary syndromes

KW - Biomarkers

KW - Chest pain

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KW - Emergency medicine

KW - Myocardial infarction

KW - Troponin

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