Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Cardiovascular Sciences Research Group, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
Heart. 2019 May;105(10):768-774. doi: 10.1136/heartjnl-2018-313825. Epub 2019 Jan 12.
The rapid turnaround time of point-of-care (POC) cardiac troponin (cTn) assays is highly attractive for crowded emergency departments (EDs). We evaluated the diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a POC cTn assay.
In a prospective diagnostic accuracy study at eight EDs, we included patients with suspected acute coronary syndromes (ACS). Blood drawn on arrival and 3 hours later was analysed for POC cTnI (i-Stat, Abbott Point of Care). The primary outcome was a diagnosis of ACS, which included both an adjudicated diagnosis of acute myocardial infarction (AMI) based on serial laboratory cTn testing and major adverse cardiac events (death, AMI or coronary revascularisation) within 30 days.
Of 716 patients included, 105 (14.7%) had ACS. Using serial POC cTnI concentrations over 3 hours could have 'ruled out' ACS in 198 (31.2%) patients with a sensitivity of 99.0% (95% CI 94.4% to 100.0%) and negative predictive value 99.5% (95% CI 96.5% to 99.9%). No AMIs were missed. T-MACS 'ruled in' ACS for 65 (10.4%) patients with a positive predictive value of 91.2% (95% CI 82.1% to 95.9%) and specificity 98.9% (97.6% to 99.6%).
With a POC cTnI assay, T-MACS could 'rule out' ACS for approximately one-third of patients within 3 hours while 'ruling in' ACS for another 10%. The rapid turnaround time and portability of the POC assay make this an attractive pathway for use in crowded EDs or urgent care centres. Future work should also evaluate use in the prehospital environment.
即时检测（POC）心脏肌钙蛋白（cTn）检测的快速周转时间对拥挤的急诊科（ED）极具吸引力。我们评估了 POCT-MACS 决策辅助工具与 POC cTn 检测的诊断准确性。
在 8 家 ED 的前瞻性诊断准确性研究中，我们纳入了疑似急性冠状动脉综合征（ACS）的患者。在到达时和 3 小时后采集的血液用于分析 POC cTnI（i-Stat，雅培即时检测）。主要结局是 ACS 的诊断，包括基于连续实验室 cTn 检测的急性心肌梗死（AMI）的明确诊断和 30 天内的主要不良心脏事件（死亡、AMI 或冠状动脉血运重建）。
在纳入的 716 例患者中，有 105 例（14.7%）患有 ACS。使用 3 小时内的连续 POC cTnI 浓度可以排除 198 例（31.2%）患者的 ACS，其敏感性为 99.0%（95%CI 94.4%至 100.0%），阴性预测值为 99.5%（95%CI 96.5%至 99.9%）。未漏诊 AMI。T-MACS 为 65 例（10.4%）ACS 患者“确诊”，阳性预测值为 91.2%（95%CI 82.1%至 95.9%），特异性为 98.9%（97.6%至 99.6%）。
使用 POCT-MACS 检测可以在 3 小时内为大约三分之一的患者排除 ACS，而对另外 10%的患者“确诊”ACS。POC 检测的快速周转时间和便携性使其成为拥挤的 ED 或紧急护理中心的一种有吸引力的途径。未来的工作还应评估在院前环境中的应用。
