Diagnostic accuracy of single baseline measurement of Elecsys Troponin T high-sensitive assay for diagnosis of acute myocardial infarction in emergency department: systematic review and meta-analysis.
Bottom Line: The results for 14 ng/L and 3-5 ng/L cut-off values were pooled separately.However, this method should be part of a comprehensive triage strategy and may not be appropriate for patients who present less than three hours after symptom onset.PROSPERO registration number CRD42013003926.
Affiliation: Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, UK Z.Zhelev@exeter.ac.uk.Show MeSH
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Mentions: We pooled the results from 20 studies to obtain summary estimates of the sensitivity and specificity at the 14 ng/L cut-off value. When a study reported separately the results for non-ST elevation myocardial infarction and acute myocardial infarction (that is, both patients with ST and non-ST elevation myocardial infarction were included in the study cohort), we included only those for non-ST elevation myocardial infarction, which are clinically more relevant. In a similar way, when both standard troponin and high sensitivity troponin assays were used as reference tests, we included only the results obtained with high sensitivity assays because, being more sensitive, they are able to identify patients with small myocardial infarctions that would be missed by the standard assays. The target condition was acute myocardial infarction in 10 studies and non-ST elevation myocardial infarction in the remaining 10 studies; the reference test was a standard troponin assay in nine studies, high sensitivity troponin assay in eight, either standard or high sensitivity in one, both standard and high sensitivity in one, and unclear in one study. Figure 2 shows a forest plot of the coupled sensitivity and specificity with 95% confidence intervals for each study included in this meta-analysis.
Affiliation: Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, UK Z.Zhelev@exeter.ac.uk.