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: On the basis of the Cook’s distance, we found the following studies to be the most influential in the meta-analysis (in descending order): Khan et al,39 Melki et al,42 Invernizzi et al,37 and Collinson et al29 (fig 5). Of these, only Khan et al was identified as an outlier having the highest standardised residuals for specificity (fig 6). After refitting the model and leaving this study out, we observed no change in sensitivity (89.5% v 89.7%) but specificity decreased from 77.1% to 74.9%. This could be explained by the fact that this study excluded patients without coronary artery disease, thus reducing the probability of false positive results.
Affiliation: Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, UK Z.Zhelev@exeter.ac.uk.