Serial high-sensitivity cardiac troponin testing for the diagnosis of myocardial infarction: a scoping review
Hirotaka Ohtake1, Teruhiko Terasawa2, Zhivko Zhelev3
1Department of Emergency and General Internal Medicine, Fujita Health University, Toyoake, Aichi, Japan.
Insights
This scoping review found that studies on serial high-sensitivity cardiac troponin (hs-cTn) testing for myocardial infarction (MI) diagnosis primarily use two assays. High patient exclusion rates raise concerns for real-world clinical application.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Biomarker Research
Background:
- Serial measurements of high-sensitivity cardiac troponin (hs-cTn) are crucial for diagnosing myocardial infarction (MI) and assessing patient risk.
- Existing studies on hs-cTn assays and algorithms vary in practice, necessitating a comprehensive overview.
Purpose of the Study:
- To assess the diversity and practices of studies evaluating serial hs-cTn testing for MI diagnosis and 30-day outcomes in patients with suspected non-ST-segment elevation MI (NSTEMI).
- To identify common assays, algorithms, and data collection methods used in current research.
Main Methods:
- A scoping review methodology was employed, searching multiple databases (MEDLINE, EMBASE, etc.) for studies published between January 2006 and November 2021.
- Eligible studies focused on the diagnostic accuracy of serial hs-cTn testing in emergency department patients with suspected NSTEMI.
Main Results:
- 86 publications were included, predominantly from Europe, North America, and Australasia, with Abbott and Roche assays being the most evaluated.
- Most studies used two time points for hs-cTn measurement and assessed two- or three-strata algorithms.
- Despite prospective data collection in most studies, significant patient exclusion rates (0%-90%) due to missing data were reported in 62% of studies.
Conclusions:
- The evidence base for serial hs-cTn testing accuracy is concentrated in specific research centers and relies heavily on two assays.
- High patient exclusion rates in reviewed studies raise concerns regarding the generalizability and direct clinical application of findings in frontline emergency departments.
Objectives:
We aimed to assess the diversity and practices of existing studies on several assays and algorithms for serial measurements of high-sensitivity cardiac troponin (hs-cTn) for risk stratification and the diagnosis of myocardial infarction (MI) and 30-day outcomes in patients suspected of having non-ST-segment elevation MI (NSTEMI).
Methods:
We searched multiple databases including MEDLINE, EMBASE, Science Citation Index, the Cochrane Database of Systematic Reviews and the CENTRAL databases for studies published between January 2006 and November 2021. Studies that assessed the diagnostic accuracy of serial hs-cTn testing in patients suspected of having NSTEMI in the emergency department (ED) were eligible. Data were analysed using the scoping review method.
Results:
We included 86 publications, mainly from research centres in Europe, North America and Australasia. Two hs-cTn assays, manufactured by Abbott (43/86) and Roche (53/86), dominated the evaluations. The studies most commonly measured the concentrations of hs-cTn at two time points, at presentation and a few hours thereafter, to assess the two-strata or three-strata algorithm for diagnosing or ruling out MI. Although data from 83 studies (97%) were prospectively collected, 0%-90% of the eligible patients were excluded from the analysis due to missing blood samples or the lack of a final diagnosis in 53 studies (62%) that reported relevant data. Only 19 studies (22%) reported on head-to-head comparisons of alternative assays.
Conclusion:
Evidence on the accuracy of serial hs-cTn testing was largely derived from selected research institutions and relied on two specific assays. The proportions of the eligible patients excluded from the study raise concerns about directly applying the study findings to clinical practice in frontline EDs.
Prospero Registration Number:
CRD42018106379.
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