![]() 1, 2 The turnaround time between a blood draw and the reporting of assay results is an important limiting factor to rapid decision making. High-sensitivity cardiac troponin (hs-cTn) assays have been shown to have sufficient accuracy at low concentrations to enable AMI to be ruled out in a large proportion of patients after analysis of just 1 blood sample taken on presentation to the emergency department (ED). Strategies that reduce the time taken to rule out AMI may rationalize the use of resources and accelerate safe discharge of low-risk patients. Investigation of patients with possible acute myocardial infarction (AMI) is a common clinical scenario associated with significant health care resource burden. Use in the ED may facilitate earlier decision making and could expedite the safe discharge of a large proportion of low-risk patients. ![]() In comparison, an hs-cTnI assay result of less than 3 ng/L identified 154 patients (43.5%) as low risk, with a sensitivity of 100% (95% CI, 93.7%-100%) and a negative predictive value of 100% (95% CI, 97.6%-100%).Ĭonclusions and Relevance A novel point-of-care troponin assay that can produce a result 15 minutes after blood sampling had comparable discrimination ability to an hs-cTnI assay for ruling out AMI after a single blood test. ![]() A TnI-Nx assay result of less than 11 ng/L identified 201 patients (56.7%) as low risk, with a sensitivity of 100% (95% CI, 93.7%-100%) and a negative predictive value of 100% (95% CI, 98.2%-100%). No difference was found between the AUC of the TnI-Nx assay (0.975 ) and the hs-cTnI assay (0.970 P = .46). Eighty-five patients (24.0%) presented to the ED less than 3 hours after symptom onset. Results Of 354 patients (255 men mean age, 62 years), 57 (16.1%) experienced an AMI. We compared the discrimination ability of the TnI-Nx assay with the hs-cTnI assay using the area under receiver operator characteristic curve (AUC) and sensitivity, negative predictive value, and the proportion of negative test results at thresholds with 100% sensitivity. Main Outcomes and Measures The primary outcome was type 1 AMI during index presentation. Troponin concentrations were measured on ED arrival with both a novel point-of-care assay (i-STAT TnI-Nx Abbott Point of Care) and a high-sensitivity troponin I assay (Architect hs-cTnI Abbott Diagnostics). Adults presenting acutely from the community to the ED with symptoms suggestive of AMI were included. Objective To determine the clinical accuracy for AMI of a single troponin concentration measured on arrival to ED with a new-generation, higher precision point-of-care assay with a 15-minute turnaround time.ĭesign, Setting, and Participants This observational study occurred at a single urban regional ED. Development of point-of-care troponin assays with greater analytical precision could reduce the decision-making time in EDs for ruling out AMI. Current point-of-care troponin assays shorten test turnaround times but lack precision at lower concentrations. Importance Emergency department (ED) investigations of patients with suspected acute myocardial infarction (AMI) are time consuming, partly because of the turnaround time of laboratory tests. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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