Low Concentrations of High-Sensitivity Troponin T at Presentation to the Emergency Department

[摘要] To the Editor:Several issues around rule-out strategies utilizing low concentrations of high-sensitivity cardiac troponin assays taken at presentation to the Emergency Department (ED)1 remain unexplored. First, large-scale analyses investigating cutoff concentrations for high-sensitivity cardiac troponin I (hs-cTnI; Abbott Architect) <99th percentile, have failed to investigate outcomes that incorporate the full spectrum of clinically relevant acute coronary syndromes, namely emergency revascularization (1, 2). Second, whether these strategies work with the high-sensitivity cardiac troponin T (hs-cTnT; Roche Elecsys) assay is underexplored. Finally, the impact of laboratory rounding (i.e., rounding the reported value up or down to the next whole integer depending on the exact post–decimal point value—e.g., 4.5 ng/L to 5 ng/L) upon diagnostic performance at low cutoff concentrations, and how this effects the proportion of patients potentially eligible for early discharge, remains unknown.In this post hoc analysis of a prospectively recruited cohort we aimed to establish the diagnostic performance of a single hs-cTnT result taken at ED presentation in patients with a nonischemic electrocardiogram (ECG), using the limit of detection (LoD) and additional cutoff concentrations <99th percentile, and also the impact of laboratory rounding.The methods and results of the primary analysis have been published previously, including reporting of diagnostic accuracy at the LoD …

[学科分类] 过敏症与临床免疫学