Suspected myocardial infarction in the emergency department : An evaluation of clinical thresholds for the Beckman Coulter Access hsTnI high-sensitivity cardiac troponin I assay

Journal article


Meek, Robert, Cullen, Louise, Lu, Zhong, Nasis, Arthur, Kuhn, Lisa and Sorace, Laurence. (2023). Suspected myocardial infarction in the emergency department : An evaluation of clinical thresholds for the Beckman Coulter Access hsTnI high-sensitivity cardiac troponin I assay. Emergency Medicine Australasia. 35(6), pp. 1005-1012. https://doi.org/10.1111/1742-6723.14282
AuthorsMeek, Robert, Cullen, Louise, Lu, Zhong, Nasis, Arthur, Kuhn, Lisa and Sorace, Laurence
Abstract

Objective
The primary objective was to determine rapid rule-out (RRO) criteria for the outcome of myocardial infarction (MI) using the Beckman Coulter Access high-sensitivity cardiac troponin I (hs-cTnI) assay. Secondary objectives were to explore cut-points for rapid rule-in (RRI) and amount of change at 3-h (3-h delta) indicative of MI.

Methods
A retrospective study included ED patients with suspected MI between June and September 2019. hs-cTnI levels were performed at baseline and after 3 h. The performance benchmark for RRO criteria was a negative predictive value (NPV) for MI with a lower 95% confidence limit >99%, and for RRI and 3-h delta cut-points was a positive predictive value (PPV) for MI >70%. Delta calculation required rising hs-cTnI levels, with at least one above the 99th percentile of the upper reference limit. Analyses utilised receiver operating characteristic (ROC) curves and contingency tables.

Results
Baseline hs-cTnI levels from 935 patients were available for RRO analyses. Of tested criteria, baseline hs-cTnI <6 ng/L (females) or <11 ng/L (males) plus symptom onset >2 h met the performance benchmark (NPV: 100% [95% confidence interval 99–100]). hs-cTnI levels were available for RRI and 3-h delta analyses from 935 and 52 patients, respectively. A 3-h delta cut-point >35 ng/L met the performance benchmark (PPV: 81% [95% confidence interval 58–95]) but no RRI cut-point did so.

Conclusions
For the Beckman Coulter Access hs-cTnI assay, RRO criteria of baseline hs-cTnI <6 ng/L (females) or <11 ng/L (males) plus symptom onset >2 h met our performance benchmark. A 3-h delta cut-point >35 ng/L met the performance benchmark, but poor precision means further adequately powered research is required.

Keywordsemergency department; high-sensitivity troponin I; myocardial infarction; patient safety; symptom assessment
Year2023
JournalEmergency Medicine Australasia
Journal citation35 (6), pp. 1005-1012
PublisherJohn Wiley & Sons Australia, Ltd
ISSN1742-6731
Digital Object Identifier (DOI)https://doi.org/10.1111/1742-6723.14282
PubMed ID37442553
Scopus EID2-s2.0-85165196007
Open accessPublished as ‘gold’ (paid) open access
Page range1005-1012
FunderBeckman Coulter, Inc.
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online13 Jul 2023
Publication process dates
Accepted26 Jun 2023
Deposited03 Apr 2025
Additional information

© 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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