Diagnostic accuracy of high-sensitivity point-of-care troponin assays in emergency department for patients presenting with chest pain: a systematic review.
Lara E van Daalen, Bart L F Schueler, Paul O Collinson et al.
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In 30 seconds
This systematic review assessed the diagnostic accuracy of four commercially available high-sensitivity point-of-care troponin assays in adults presenting to emergency departments with chest pain suggestive of acute coronary syndrome. Eleven derivation and validation studies included 10 115 patients. The assays performed best as single-test rule-out tools at ED arrival when troponin values were very low. For example, Atellica VTLi at less than 4 ng/L had sensitivity of 98.8-100% and negative predictive value of 99.8-100%; performance varied by assay and threshold.
Key findings
- Atellica VTLi at less than 4 ng/L had sensitivity of 98.8-100% and NPV of 99.8-100%; at less than 7 ng/L, sensitivity and NPV were both 100%.
- Pathfast at less than 3 ng/L had sensitivity of 96.3-100% and NPV of 98.1-100%.
- i-STAT at less than 5 ng/L had sensitivity of 99.8% and NPV of 100%; TriageTrue at less than 3 ng/L had sensitivity and NPV of 100%.
- With 99th-percentile thresholds and 0 + 1/2/3 h protocols, reported sensitivity ranged from 64.8-100% for VTLi, and was 87% for Pathfast plasma, 83% for Pathfast whole blood, and 79.8% for TriageTrue.
Why it matters
Rapid rule-out of acute myocardial infarction could shorten diagnostic pathways for patients with chest pain in the emergency department. The review suggests that very low arrival troponin values may support this use, while the differing results across assays and testing strategies underscore the importance of interpreting performance in the context of the specific device and protocol.
What to keep in mind
The review included 11 studies, comprising both derivation and validation studies, and reported variable performance across assays and thresholds.