Journal
JAMA CARDIOLOGY
Volume 3, Issue 11, Pages 1108-1112Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jamacardio.2018.3368
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Funding
- Abbott Point of Care
- Emergency Care Foundation
- Canterbury Medical Research Foundation
- Canterbury District Health Board
- New Zealand Health Research Council
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IMPORTANCE Emergency department (ED) investigations of patients with suspected acute myocardial infarction (AMI) are time consuming, partly because of the turnaround time of laboratory tests. Current point-of-care troponin assays shorten test turnaround times but lack precision at lower concentrations. Development of point-of-care troponin assays with greater analytical precision could reduce the decision-making time in EDs for ruling out AMI. OBJECTIVE To determine the clinical accuracy for AMI of a single troponin concentration measured on arrival to ED with a new-generation, higher precision point-of-care assay with a 15-minute turnaround time. DESIGN, SETTING, AND PARTICIPANTS This observational study occurred at a single urban regional ED. Adults presenting acutely from the community to the ED with symptoms suggestive of AMI were included. Troponin concentrations were measured on ED arrival with both a novel point-of-care assay (i-STAT Tnl-Nx; Abbott Point of Care) and a high-sensitivity troponin I assay (Architect hs-cTnl; Abbott Diagnostics). MAIN OUTCOMES AND MEASURES The primary outcome was type 1 AMI during index presentation. We compared the discrimination ability of the Tnl-Nx assay with the hs-cTnl assay using the area under receiver operator characteristic curve (AUC) and sensitivity, negative predictive value, and the proportion of negative test results at thresholds with 100% sensitivity. RESULTS Of 354 patients (255 [72.0%] men; mean [SD] age. 62 [12] years), 57 (16.1%) experienced an AMI. Eighty-five patients (24.0%) presented to the ED less than 3 hours after symptom onset. No difference was found between the AUC of the Tnl-Nx assay (0.975 [95% CI, 0.958-0.993]) and the hs-cTnl assay (0.970 [95% CI, 0.949 to 0.990]; P = .46). A Tnl-Nx assay result of less than 11 ng/L identified 201 patients (56.7%) as low risk, with a sensitivity of 100% (95% CI, 93.7%-100%) and a negative predictive value of 100% (95% CI, 98.2%-100%). In comparison, an hs-cTnl assay result of less than 3 ng/L identified 154 patients (415%) as low risk, with a sensitivity of 100% (95% CI, 933%100%) and a negative predictive value of 100% (95% CI, 976%-100%). CONCLUSIONS AND RELEVANCE A novel point-of-care troponin assay that can produce a result 15 minutes after blood sampling had comparable discrimination ability to an hs-cTnl assay for ruling out AMI after a single blood test. Use in the ED may facilitate earlier decision making and could expedite the safe discharge of a large proportion of low-risk patients.
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