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: Seven papers reported the results for 3 ng/L and/or 5 ng/L cut-off values at presentation.5192228344353 Given the small number of studies, pooling the data for each cut-off value separately would have produced unreliable results. Instead, we decided to obtain more precise and reliable summary estimates by including in the meta-analysis all independent 3 ng/L and 5 ng/L data.51922283453 Two studies reported the results for both cut-off values.224353 As in this analysis we were interested mainly in the sensitivity of the test (its accuracy for ruling out acute myocardial infarction), we decided to include the results for 5 ng/L as the performance at a higher cut-off value would produce a lower sensitivity estimate thus representing the worse case scenario. Owing to the inverse correlation between sensitivity and specificity, we could assume that using even lower cut-off values would further increase the sensitivity of the assay and its ability to rule out the target condition. Thus, from the APACE trial we excluded the results reported by Meune et al,43 included those reported by Rubini Gimenez et al,53 and included only the 5 ng/L data reported by Aldous et al.22 Also, Christ et al reported two different sets of 3 ng/L results, obtained using standard troponin T and high sensitivity troponin T as refrence assays.28 As in the previous analysis, we included the results obtained by using high sensitivity troponin T as a reference assay, which is more sensitive and, thefeore, more likely to capture small myocardial infarctions. Figure 7 shows a forest plot of the sensitivities and specificities of the included studies. Pooling the results from the six studies produced the following summary estimates: sensitivity 97.4% (94.9% to 98.7%), specificity 42.4% (31.2% to 54.5%), positive likelihood ratio 1.69 (1.40 to 2.05), and negative likelihood ratio 0.06 (0.04 to 0.10) (fig 8).
Affiliation: Institute of Health Research, University of Exeter Medical School, Exeter EX2 4SG, UK Z.Zhelev@exeter.ac.uk.