Diagnostic accuracy of a point-of-care troponin i assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain

Deborah B. Diercks, W. Frank Peacock IV, Judd E. Hollander, Adam J. Singer, Robert Birkhahn, Nathan Shapiro, Ted Glynn, Richard Nowack, Basmah Safdar, Chadwick D. Miller, Elizabeth Lewandrowski, John T. Nagurney

Research output: Contribution to journalArticle

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Abstract

Background: Guidelines recommend that serial cardiac marker testing to rule out acute myocardial infarction (AMI) be performed for 8 to 12 hours after symptom onset. We aim to determine the diagnostic accuracy of a contemporary point-of-care (POC) troponin I (TnI) assay within 3 hours for patients presenting within 8 hours of symptom onset. Methods: The MIDAS study collected blood from patients presenting with suspected acute coronary syndrome at presentation and at 90 minutes, 3 hours, and 6 hours in whom the emergency physician planned an objective cardiac ischemia evaluation. Criterion standard diagnoses were adjudicated by experienced clinicians using all available medical records per American Heart Association/American College of Cardiology criteria. Reviewers were blinded to the investigational marker, Cardio3 TnI POC. The Cardio3 TnI reference value was defined as >0.05 ng/mL. Measures of diagnostic accuracy are presented with 95% CI. Results: A total of 858 of 1107 patients met the inclusion criteria. The study cohort had 476 men (55.5%) with median age of 57.0 years (interquartile range 48.0-67.0 years). Median time from symptom onset to initial blood draw was 3.9 hours (interquartile range 2.7-5.2 hours). Acute myocardial infarction was diagnosed in 82 patients (9.6%). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio over 3 hours were 84.1, 93.4, 12.8, and 0.17, respectively. There was no significant improvement in diagnostic accuracy associated with adding 6-hour serial testing to the 3-hour sample. Conclusion: In suspected patients with acute coronary syndrome presenting to the emergency department within 8 hours of symptom onset, 3 hours of serial testing with the Cardio3 TnI POC platform provides similar diagnostic accuracy for AMI as longer periods.

Original languageEnglish (US)
JournalAmerican Heart Journal
Volume163
Issue number1
DOIs
StatePublished - Jan 2012

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Point-of-Care Systems
Troponin
Chest Pain
Troponin I
Hospital Emergency Service
Myocardial Infarction
Acute Coronary Syndrome
Medical Records
Reference Values
Emergencies
Cohort Studies
Ischemia
Guidelines
Physicians
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Diagnostic accuracy of a point-of-care troponin i assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. / Diercks, Deborah B.; Peacock IV, W. Frank; Hollander, Judd E.; Singer, Adam J.; Birkhahn, Robert; Shapiro, Nathan; Glynn, Ted; Nowack, Richard; Safdar, Basmah; Miller, Chadwick D.; Lewandrowski, Elizabeth; Nagurney, John T.

In: American Heart Journal, Vol. 163, No. 1, 01.2012.

Research output: Contribution to journalArticle

Diercks, DB, Peacock IV, WF, Hollander, JE, Singer, AJ, Birkhahn, R, Shapiro, N, Glynn, T, Nowack, R, Safdar, B, Miller, CD, Lewandrowski, E & Nagurney, JT 2012, 'Diagnostic accuracy of a point-of-care troponin i assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain', American Heart Journal, vol. 163, no. 1. https://doi.org/10.1016/j.ahj.2011.09.028
Diercks, Deborah B. ; Peacock IV, W. Frank ; Hollander, Judd E. ; Singer, Adam J. ; Birkhahn, Robert ; Shapiro, Nathan ; Glynn, Ted ; Nowack, Richard ; Safdar, Basmah ; Miller, Chadwick D. ; Lewandrowski, Elizabeth ; Nagurney, John T. / Diagnostic accuracy of a point-of-care troponin i assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. In: American Heart Journal. 2012 ; Vol. 163, No. 1.
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abstract = "Background: Guidelines recommend that serial cardiac marker testing to rule out acute myocardial infarction (AMI) be performed for 8 to 12 hours after symptom onset. We aim to determine the diagnostic accuracy of a contemporary point-of-care (POC) troponin I (TnI) assay within 3 hours for patients presenting within 8 hours of symptom onset. Methods: The MIDAS study collected blood from patients presenting with suspected acute coronary syndrome at presentation and at 90 minutes, 3 hours, and 6 hours in whom the emergency physician planned an objective cardiac ischemia evaluation. Criterion standard diagnoses were adjudicated by experienced clinicians using all available medical records per American Heart Association/American College of Cardiology criteria. Reviewers were blinded to the investigational marker, Cardio3 TnI POC. The Cardio3 TnI reference value was defined as >0.05 ng/mL. Measures of diagnostic accuracy are presented with 95{\%} CI. Results: A total of 858 of 1107 patients met the inclusion criteria. The study cohort had 476 men (55.5{\%}) with median age of 57.0 years (interquartile range 48.0-67.0 years). Median time from symptom onset to initial blood draw was 3.9 hours (interquartile range 2.7-5.2 hours). Acute myocardial infarction was diagnosed in 82 patients (9.6{\%}). The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio over 3 hours were 84.1, 93.4, 12.8, and 0.17, respectively. There was no significant improvement in diagnostic accuracy associated with adding 6-hour serial testing to the 3-hour sample. Conclusion: In suspected patients with acute coronary syndrome presenting to the emergency department within 8 hours of symptom onset, 3 hours of serial testing with the Cardio3 TnI POC platform provides similar diagnostic accuracy for AMI as longer periods.",
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AU - Hollander, Judd E.

AU - Singer, Adam J.

AU - Birkhahn, Robert

AU - Shapiro, Nathan

AU - Glynn, Ted

AU - Nowack, Richard

AU - Safdar, Basmah

AU - Miller, Chadwick D.

AU - Lewandrowski, Elizabeth

AU - Nagurney, John T.

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