Abstract 14583: Value of High Sensitivity Troponin Assays in Non Selected Patients With Chest Pain Admitted to Emergency Department
Early diagnosis of acute coronary syndrome (ACS) and the proper management of chest pain pts still represents a clinical challenge in the emergency department (ED). International guidelines recommend cardiac troponins (cTnI, cTnT), as the biochemical gold standard for the detection/exclusion of myocardial infarction (MI). The recent commercially available highly sensitive (hs) cTn assays (hs-cTn) shortening the time to test's positivity promise a higher sensitivity for the diagnosis of ACS. We compared hs and conventional cTn assays for the early diagnosis of ACS. 356 consecutive pts (218 males, 138 females; age 63, range 15–94 years) admitted to ED within 12 hours from chest pain onset (<3 hours=32%, 3–6 hours=17%, >6 hours=51%) were enrolled. 113 out of 356 pts (32%) were admitted to hospital whereas 243 were discharged from ED. cTn serum levels were determined in the admission samples using 3 conventional and 3 hs assays: Troponin T (cTnT-R, Roche Diagnostics), ST AIA-PACK cTnI-3rd generation (cTnI-T, Tosoh), Access AccuTnI (cTnI-B, Beckman Coulter) and high sensitivity Troponin T (hs-cTnT-R, Roche Diagnostics), CTNI Loci (hs-cTnI-S, Siemens), TnI-Ultra (hs-cTnI-A, Siemens). The diagnostic accuracy for diagnosis of ACS among the different cTn assays was evaluated calculating the Area Under the Curve (AUC) by the Receiver-Operating Characteristic (ROC) curve. 36 out of 356 pts (10%) were discharged with a diagnosis of ACS. A statistically significant difference was found comparing the AUC of the hs-cTnT-R assay vs. the 3 traditional cTn assays and vs. 1 of the other 2 hs-cTn assays (p): hs-cTnT-R vs. cTnT-R (0.0070), hs-cTnT-R vs. cTnI-T (0.0040), hs-cTnT-R vs. cTnI-B (0.0249), hs-cTnT-R vs. hs-cTnI-S (0.0072). Our results show that in a real-world setting with low prevalence of ACS in ED, hs-cTn assays could improve significantly the diagnosis of ACS in comparison to traditional troponin assays. Moreover, the observed diagnostic accuracy of the hs-cTn assays might be underestimated due to the large proportion of pts (>50%) presented to ED with a time from symptoms onset longer than 6 hours: the long time elapsing between pain onset and ED sampling may have reduced the potential advantage of the hs-troponin assays utilization.
- © 2010 by American Heart Association, Inc.