Comprehensive Review of High-Sensitivity Troponin Algorithms and Accelerated Diagnostic Protocols
This review systematically compares the diagnostic and prognostic performance of hs-cTn strategies, from single-draw limit-of-detection rule-out through 0/1-h, 0/2-h, and 0/3-h serial algorithms, to multi-marker accelerated diagnostic protocols. While hs-cTn algorithms maximize rapid rule-out rates, ADPs that incorporate clinical risk scores offer superior prognostic assessment. The authors highlight a critical evidence gap: prospective implementation data exist mainly for ADPs, not for the widely promoted 0/1-h algorithms.
The original study
High-Sensitivity Cardiac Troponin-Based Strategies for the Assessment of Chest Pain Patients-A Review of Validation and Clinical Implementation Studies.
- Authors
- Eggers KM, Jernberg T, Ljung L, Lindahl B
- Journal
- Clinical chemistry
- Type
- Journal Article, Review
- PMID
- 29941466
Original abstract
BACKGROUND: The introduction of high-sensitivity cardiac troponin (hs-cTn) assays has improved the early assessment of chest pain patients. A number of hs-cTn-based algorithms and accelerated diagnostic protocols (ADPs) have been developed and tested subsequently. In this review, we summarize the data on the performance and clinical utility of these strategies. CONTENT: We reviewed studies investigating the diagnostic and prognostic performance of hs-cTn algorithms [level of detection (LoD) strategy, 0/1-h, 0/2-h, and 0/3-h algorithms) and of hs-cTn-based ADPs, together with the implications of these strategies when implemented as clinical routine. The LoD strategy, when combined with a nonischemic electrocardiogram, is best suited for safe rule-out of myocardial infarction and the identification of patients eligible for early discharge from the emergency department. The 0/1-h algorithms appear to identify most patients as being eligible for rule-out. The hs-cTn-based ADPs mainly focus on prognostic assessment, which is in contrast with the hs-cTn algorithms. They identify smaller proportions of rule-out patients, but there is increasing evidence from prospective studies on their successful clinical implementation. Such information is currently lacking for hs-cTn algorithms. CONCLUSIONS: There is a trade-off between safety and efficacy for different hs-cTn-based strategies. This trade-off should be considered for the intended strategy, along with its user-friendliness and evidence from clinical implementation studies. However, several gaps in knowledge remain. At present, we suggest the use of an ADP in conjunction with serial hs-cTn results to optimize the early assessment of chest pain patients.