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Meta-Analysis
. 2020 Feb;9(1):14-22.
doi: 10.1177/2048872618819421. Epub 2019 Jan 8.

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

M Arslan  1 , A Dedic  1 , E Boersma  1   2 , E A Dubois  1
Affiliations
Meta-Analysis

Serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and a single high baseline measurement for swift rule-in: A systematic review and meta-analysis

M Arslan et al. Eur Heart J Acute Cardiovasc Care. 2020 Feb.

Abstract

Aims: The purpose of this study was to determine (a) the ability of serial high-sensitivity cardiac troponin T measurements to rule out acute myocardial infarction and (b) the ability of a single high baseline high-sensitivity cardiac troponin T measurement to rule in acute myocardial infarction in patients presenting to the emergency department with acute chest pain.

Methods and results: Embase, Medline, Cochrane, Web of Science and Google scholar were searched for prospective cohort studies that evaluated parameters of diagnostic accuracy of serial high-sensitivity cardiac troponin T to rule out acute myocardial infarction and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction. The search yielded 21 studies for the systematic review, of which 14 were included in the meta-analysis, with a total of 11,929 patients and an overall prevalence of acute myocardial infarction of 13.0%. For rule-out, six studies presented the sensitivity of serial measurements <14 ng/l. This cut-off classified 60.1% of patients as rule-out and the summary sensitivity was 96.7% (95% confidence interval: 92.3-99.3). Three studies presented the sensitivity of a one-hour algorithm with a baseline high-sensitivity cardiac troponin T value<12 ng/l and delta 1 hour <3 ng/l. This algorithm classified 60.2% of patients as rule-out and the summary sensitivity was 98.9% (96.4-100). For rule-in, six studies reported the specificity of baseline high-sensitivity cardiac troponin T value>50 ng/l. The summary specificity was 94.6% (91.5-97.1).

Conclusion: Serial high-sensitivity cardiac troponin T measurement strategies to rule out acute myocardial infarction perform well, and a single baseline high-sensitivity cardiac troponin T value>50 ng/l to rule in acute myocardial infarction has a high specificity.

Keywords: Acute myocardial infarction; high-sensitivity cardiac troponin T; rule-in; rule-out.

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Conflict of interest statement

Conflict of interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow diagram: study inclusion process for the systematic review and meta-analysis. AMI: acute myocardial infarction; hs-cTnT: high-sensitivity cardiac troponin T.
Figure 2.
Figure 2.
Forest plot displaying the summary estimate of sensitivity of serial high-sensitivity cardiac troponin T (hs-cTnT) measurements <14 ng/l (99th percentile). AMI: acute myocardial infarction; CI: confidence interval; cTnI: cardiac troponin I; FN: false negative; NSTEMI: non-ST segment elevation myocardial infarction; TP: true positive.
Figure 3.
Figure 3.
Forest plot displaying the summary estimate of sensitivity of high-sensitivity cardiac troponin T (hs-cTnT) <12 ng/l and Δ1 h<3 ng/l. AMI: acute myocardial infarction; CI: confidence interval; cTnI: cardiac troponin I; FN: false negative; NSTEMI: non-ST segment elevation myocardial infarction; TP: true positive.
Figure 4.
Figure 4.
Forest plot displaying the summary estimate of specificity of a baseline high-sensitivity cardiac troponin T (hs-cTnT) value>50 ng/l. AMI: acute myocardial infarction; CI: confidence interval; cTnI: cardiac troponin I; cTnT: cardiac troponin T; FP: false positive; NSTEMI: non-ST segment elevation myocardial infarction; POC-TnT: point-of-care troponin T; TN: true negative.
See this image and copyright information in PMC

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