Validation of Rapid Rule-Out Criteria Using the Beckman Access hsTnI Assay for Patients With Suspected Myocardial
Robert Meek1,2, Oliver Weiner1, Somesh Venkatesan3
1Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia.
Insights
The Monash Health criteria for rapid rule-out of myocardial infarction (MI) demonstrated 100% sensitivity and negative predictive value in a tertiary cardiac emergency setting. These findings support the external validity of the criteria for efficiently ruling out MI.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Accuracy
Background:
- Myocardial infarction (MI) diagnosis requires timely and accurate assessment in emergency settings.
- The Monash Health criteria offer a rapid rule-out (RRO) pathway for suspected MI.
- External validation of RRO criteria in diverse clinical environments is crucial for generalizability.
Purpose of the Study:
- To externally validate the existing Monash Health rapid rule-out (RRO) criteria for myocardial infarction (MI).
- To assess the performance of RRO criteria at a tertiary cardiac emergency (CE) department.
- To determine the sensitivity and negative predictive value (NPV) of the RRO criteria for index MI.
Main Methods:
- A prospective study included 1253 patients with suspected MI at the Victorian Heart Hospital CE (April-June 2023).
- Exclusion criteria included ST-elevation MI on initial ECG.
- Monash Health RRO thresholds for high-sensitivity cardiac-troponin-I (hs-cTnI) were applied, alongside criteria for symptom onset and ECG findings. MI diagnosis was confirmed by expert consensus.
Main Results:
- The RRO criteria achieved 100% sensitivity and 100% NPV for MI in the study population.
- 334 (26.7%) patients met the RRO criteria.
- Patients meeting RRO criteria were younger and less likely to be admitted compared to those who did not.
Conclusions:
- The Monash Health RRO criteria, originally derived in a general emergency department, demonstrated high sensitivity and NPV in a tertiary cardiac emergency setting.
- These findings support the external validity and applicability of the RRO criteria in specialized cardiac emergency departments.
- The RRO criteria can be reliably used for the rapid and accurate exclusion of MI in this setting.
Objective:
To externally validate the current Monash Health criteria for rapid rule-out (RRO) of myocardial infarction (MI) at a tertiary cardiac emergency (CE).
Methods:
All patients with suspected MI at the Victorian Heart Hospital (VHH) CE from April to June 2023 were eligible. Those with ST-elevation MI diagnosis from the initial ECG were excluded. The Monash Health RRO thresholds for the Access hsTnI laboratory high-sensitivity cardiac-troponin-I (hs-cTnI) assay are < 6 ng/L (females) or < 11 ng/L (males). The RRO criteria, derived at a general emergency department (ED) also require symptom onset > 2-h pre-hs-cTnI test and an ECG with no new ischaemic changes. MI diagnosis was determined by cardiologist-emergency physician consensus. The primary objective was the demonstration of RRO criteria performance in the VHH CE population, with sensitivity and negative predictive value (NPV) for index MI > 99%. Patient characteristics were also compared for those meeting RRO criteria or not.
Results:
For the 1253 eligible patients, median age was 66 years [IQR: 53, 78] and 686 (54.7%) were male. Of the total, 334 (26.7%) met RRO criteria. The NPV for MI was 100% (95% CI: 98.9, 100.0), with sensitivity 100% (95% CI: 96.5, 100.0). Those meeting RRO criteria were younger (60 [IQR: 49, 72] vs. 68 [IQR: 56, 80] years) and less likely to be admitted (21.9% [95% CI: 17.5, 26.7] vs 49.6% [95% CI: 46.3, 52.9]).
Conclusions:
RRO criteria derived in a general ED population had a similarly high sensitivity and NPV for MI at a tertiary CE department. This supports external validity.
More Related Videos
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
05:26Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...