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: As shown in figures 2 and 3, a significant level of heterogeneity was apparent in the results, greater in specificity than in sensitivity. We investigated the effect of the target condition (acute myocardial infarction versus non-ST elevation myocardial infarction) and the reference test (standard versus high sensitivity troponin assay) on the summary estimates of sensitivity and specificity by adding them as covariates to a bivariate regression model (one covariate at a time) and used a likelihood ratio test to determine the statistical significance of the results. As in two studies a combination of standard and high sensitivity assays were used as a reference test,2941 and the type of the reference assay was unclear in another study,36 we excluded those three studies from the meta-regression. Without them, the likelihood ratio test showed that the use of different reference standards accounts for some of the variability in the sensitivity (P=0.008) but not in the specificity (P=0.66) (fig 4). A model that allowed for sensitivity and its variance to vary between studies using different reference tests (standard versus high sensitivity assays) produced the following summary estimates: sensitivity (standard reference assay) 87.7% (82.6% to 89.9%), sensitivity (high sensitivity reference assay) 93.4% (89.8% to 95.7%), specificity 74.7% (73.6% to 75.8%), positive likelihood ratio (standard reference assay) 3.43 (3.08 to 3.82), positive likelihood ratio (high sensitivity reference assay) 3.69 (3.13 to 4.36), negative likelihood ratio (standard reference assay) 0.18 (0.14 to 0.23), negative likelihood ratio (high sensitivity reference assay) 0.09 (0.06 to 0.14). The target condition, on the other hand, had no effect on the results (P=0.79).
Affiliation: Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, UK Z.Zhelev@exeter.ac.uk.