Two- vs three-hour hs-cTnI algorithms for ruling out acute myocardial infarction using the Beckman access
Angela Mak1, Yi Li Chen2, Inam Khalfan2
1Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Insights
A two-hour high-sensitivity troponin I (hs-cTnI) algorithm can accurately rule out acute myocardial infarction in emergency departments. This faster protocol offers potential operational advantages over the traditional three-hour testing.
Area of Science:
- Cardiology
- Emergency Medicine
- Biochemistry
Background:
- Acute coronary syndrome (ACS) is a common reason for emergency department (ED) visits.
- High-sensitivity troponin testing is crucial for diagnosing suspected coronary disease.
- Evaluating the accuracy of 0/2-hour and 0/3-hour algorithms with the Beckman Access hs-cTnI assay is important.
Purpose of the Study:
- To synthesize evidence on the diagnostic accuracy of 0/2-hour and 0/3-hour hs-cTnI algorithms.
- To assess the reliability of the Beckman Coulter Access hs-cTnI assay in emergency settings.
Main Methods:
- Systematic literature search across Medline, Embase, and Wiley Cochrane Library.
- Screening and data extraction by a reviewer team.
- Study quality and risk assessment using the QUADAS-2 tool, adhering to PRISMA guidelines.
Main Results:
- Five studies met inclusion criteria; no direct comparison of 0/2h vs. 0/3h algorithms for the specific assay.
- Heterogeneity precluded meta-analysis; studies used varied time points for serial troponin measurements.
- Consistently high sensitivity (>97.7%) and NPV (>98.9%) reported for ruling out myocardial infarction (MI).
Conclusions:
- Two studies suggest a 2-hour hs-cTnI algorithm achieves accuracy comparable to a 3-hour protocol for MI rule-out.
- The 2-hour hs-cTnI algorithm may offer operational efficiencies in the ED compared to a 3-hour protocol.
Background:
Patients with symptoms of acute coronary syndrome make up a significant proportion of emergency department (EDs) presentations. High-sensitivity troponin testing is a standard component of evaluating patients with suspected symptomatic coronary disease. We sought to synthesize the evidence of the accuracy of 0/2-h and 0/3-h algorithms using the Beckman Access high-sensitivity cardiac troponin I (hs-cTnI) assay.
Methods:
We developed an electronic search strategy retrieving research from three electronic databases (Medline, Embase, and Wiley Cochrane Library). Relevant research studies were screened and data extracted by a team of reviewers. Study quality and risk assessment were appraised using the QUADAS-2 tool. Findings were reported according to PRISMA guidelines.
Results:
Five studies met inclusion criteria. No studies directly compared the 0 h/2 h and 0 h/3 h algorithms using the Beckman Coulter Access hs-cTnI assay, and heterogeneity in study design precluded meta-analysis. Included studies variably used 2-h, 3-h, or intermediate timepoints for serial troponin measurement. All studies reported consistently high sensitivity (> 97.7%) and NPV (> 98.9%) for ruling out acute myocardial infarction, supporting the reliability of both 0/2 h and 0/3 h hs-cTnI algorithms in the ED.
Conclusions:
Of the five studies included, two studies suggest that a two-hour hs-TnI algorithm can effectively rule out myocardial infarction with similar accuracy to a longer three-hour protocol. Use of a 2-h hs-cTnI algorithm may lead to operational gains compared to a 3-h serial testing algorithm.
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