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Comparison of diagnostic accuracy between three different rules of interpreting high sensitivity troponin T results

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Abstract

With the introduction of high sensitivity troponin-T (hs-TnT) assay, clinicians face more patients with ‘positive’ results but without myocardial infarction. Repeated hs-TnT determinations are warranted to improve specificity. The aim of this study was to compare diagnostic accuracy of three different interpretation rules for two hs-TnT results taken 6 h apart. After adjusting for clinical differences, hs-TnT results were recoded according to the three rules. Rule1: hs-TnT >13 ng/L in at least one determination. Rule2: change of >20 % between the two measures. Rule3: change >50 % if baseline hs-TnT 14–53 ng/L and >20 % if baseline >54 ng/L. The sensitivity, specificity and ROC curves were compared. The sensitivity analysis was used to generate post-test probability for any test result. Primary outcome was the evidence of coronary critical stenosis (CCS) on coronary angiography in patients with high-risk chest pain. 183 patients were analyzed (38.3 %) among all patients presenting with chest pain during the study period. CCS was found in 80 (43.7 %) cases. The specificity was 0.62 (0.52–0.71), 0.76 (0.66–0.84) and 0.83 (0.74–0.89) for rules 1, 2 and 3, respectively (P < 0.01). Sensitivity decreased with increasing specificity (P < 0.01). Overall diagnostic accuracy did not differ among the three rules (AUC curves difference P = 0.12). Sensitivity analysis showed a 25 % relative gain in predicting CCS using rule 3 compared to rule 1. Changes between two determinations of hs-TnT 6 h apart effectively improved specificity for CCS presence in high-risk chest pain patients. There was a parallel loss in sensitivity that discouraged any use of such changes as a unique way to interpret the new hs-TnT results.

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Authors and Affiliations

  1. Department of Emergency Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy

    Francesco Buccelletti, Davide Marsiliani, Paolo Iacomini, Pierpaolo Mattogno, Annarita Carroccia, Chiara Cordischi, Simone Antonini, Marta Sabbatini, Nicolò Gentiloni Silveri & Francesco Franceschi

  2. Department of Cardiology, Catholic University of the Sacred Heart, Rome, Italy

    Leonarda Galiuto & Elisa Fedele

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  1. Francesco Buccelletti
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  2. Leonarda Galiuto
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  3. Davide Marsiliani
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  4. Paolo Iacomini
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  5. Pierpaolo Mattogno
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  6. Annarita Carroccia
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  7. Chiara Cordischi
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  8. Simone Antonini
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  9. Elisa Fedele
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  10. Marta Sabbatini
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  11. Nicolò Gentiloni Silveri
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  12. Francesco Franceschi
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Correspondence to Paolo Iacomini.

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Buccelletti, F., Galiuto, L., Marsiliani, D. et al. Comparison of diagnostic accuracy between three different rules of interpreting high sensitivity troponin T results. Intern Emerg Med 7, 365–370 (2012). https://doi.org/10.1007/s11739-012-0787-8

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  • DOI: https://doi.org/10.1007/s11739-012-0787-8

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