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Evaluation of the 0 h/1 h high-sensitivity cardiac troponin T algorithm in diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) in Han population

  • Chen Dongxu , Zhou Yannan , Yang Yilin , Yao Chenling EMAIL logo , Gu Guorong EMAIL logo , Wang Kouqiong , Guo Wei , Shi Dongwei , Song Zhenju and Tong Chaoyang
Published/Copyright: December 23, 2020
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 59 Issue 4

Abstract

Objectives

A rapid 0 h/1 h algorithm using high-sensitivity cardiac troponin T (hs-cTnT) for rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) is recommended by the European Society of Cardiology. We aim to prospectively evaluate the diagnostic performance of the algorithm in Chinese Han patients with suspected NSTEMI.

Methods

In this prospective diagnostic cohort study, 577 patients presenting to the emergency department with suspected NSTEMI and recent (<12 h) onset of symptoms were enrolled. The levels of serum hs-cTnT were measured on admission, 1 h later and 4–14 h later. All patients underwent the initial clinical assessment and were triaged into three groups (rule-out, rule-in and observe) according to the 0 h/1 h algorithm. The major cardiovascular events (MACE) were evaluated at the 7-day and 30-day follow-ups.

Results

Among 577 enrolled patients, NSTEMI was the final diagnosis for 106 (18.4%) patients. Based on the hs-cTnT 0 h/1 h algorithm, 148 patients (25.6%) were classified as rule-out, 278 patients (48.2%) as rule-in and 151 patients (26.2%) were assigned to the observe group. The rule-out approach resulted in a sensitivity of 100% and negative predictive value of 100%. The rule-in approach resulted in a specificity of 62.9% [95% CI (58.5–67.2%)] and positive predictive value of 37.1% [95%CI (31.3–42.8%)]. No MACE was observed in the rule-out group within 30-day follow-up.

Conclusions

The hs-cTnT 0 h/1 h algorithm is a safe tool for early rule-out of NSTEMI, while probably not an effective strategy for accurate rule-in of NSTEMI in Chinese Han population.

Keywords: acute myocardial infarction (AMI); high-sensitivity cardiac troponin T (hs-cTnT); non-ST elevation myocardial infarction (NSTEMI)
Corresponding authors: Yao Chenling and Gu Guorong, Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, P.R. China, E-mail: ,
Chen Dongxu, Zhou Yannan and Yang Yilin contributed equally to this work and should be considered co-first authors.

Funding source: Key Project of Shanghai Municipal Health Bureau

Award Identifier / Grant number: 2016ZB0202

Funding source: The Scientific Research Project of Shanghai Municipal Health Bureau

Award Identifier / Grant number: 201940163

Funding source: Shanghai Shenkang Hospital Development Center

Award Identifier / Grant number: SHDC12019615

Acknowledgments

The authors thank the patients who participated in this research, the emergency department staff and the laboratory technicians of all participating sites for their valuable effort.

  1. Research funding: This study was supported by Key Project of Shanghai Municipal Health Bureau (2016ZB0202), the Scientific Research Project of Shanghai Municipal Health Bureau (201940163) and Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center (SHDC12019615).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study was carried out according to the principles of the Declaration of Helsinki and approved by the local Ethics Committee.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-0367).

Received: 2020-03-22
Accepted: 2020-10-12
Published Online: 2020-12-23
Published in Print: 2021-03-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2020-0367
Keywords for this article
acute myocardial infarction (AMI); high-sensitivity cardiac troponin T (hs-cTnT); non-ST elevation myocardial infarction (NSTEMI)

Articles in the same Issue

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  2. Editorials
  3. Perspectives in developments of mass spectrometry for improving diagnosis and monitoring of multiple myeloma and other plasma cell disorders
  4. Cytokine “storm”, cytokine “breeze”, or both in COVID-19?
  5. Review
  6. Clinical relevance of biological variation of cardiac troponins
  7. General Clinical Chemistry and Laboratory Medicine
  8. Development of novel methods for non-canonical myeloma protein analysis with an innovative adaptation of immunofixation electrophoresis, native top-down mass spectrometry, and middle-down de novo sequencing
  9. Falsely markedly elevated 25-hydroxyvitamin D in patients with monoclonal gammopathies
  10. Development of a pregnancy-specific reference material for thyroid biomarkers, vitamin D, and nutritional trace elements in serum
  11. Applying the concept of uncertainty to the sFlt-1/PlGF cut-offs for diagnosis and prognosis of preeclampsia
  12. Reducing sample rejection in Durban, South Africa
  13. Quality benchmarking of smartphone laboratory medicine applications: comparison of laboratory medicine specialists’ and non-laboratory medicine professionals’ evaluation
  14. Urine soluble CD163 (sCD163) as biomarker in glomerulonephritis: stability, reference interval and diagnostic performance
  15. Measurement of urine albumin by liquid chromatography-isotope dilution tandem mass spectrometry and its application to value assignment of external quality assessment samples and certification of reference materials
  16. Choice of faecal immunochemical test matters: comparison of OC-Sensor and HM-JACKarc, in the assessment of patients at high risk of colorectal cancer
  17. Reference Values and Biological Variations
  18. Reference values of trace elements in blood and/or plasma in adults living in Belgium
  19. Cancer Diagnostics
  20. Clinical performance of calcitonin and procalcitonin Elecsys® immunoassays in patients with medullary thyroid carcinoma
  21. Cardiovascular Diseases
  22. Analytical assessment of ortho clinical diagnostics high-sensitivity cardiac troponin I assay
  23. Evaluation of the 0 h/1 h high-sensitivity cardiac troponin T algorithm in diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) in Han population
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  25. Are hemoglobin A1c point-of-care analyzers fit for purpose? The story continues
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  28. Hemocytometric characteristics of COVID-19 patients with and without cytokine storm syndrome on the sysmex XN-10 hematology analyzer
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