![]() This study is the first to highlight the discordance between these assays not only in terms of measurement value, but in their overall classification, with consequences impacting decision making. Each has specific cut-points used in diagnostic algorithms, which differ due to the differences in sensitivities and reference populations used to derive these cut-points. Three high-sensitivity assays are Food and Drug Administration (FDA) approved for the measurement of troponin (Elecsys 2010 for hs-cTnT, Roche Diagnostics, Penzberg, Germany ARCHITECT i2000SR for hs-cTnI, Abbott Diagnostics, Irving, TX and HsVista for hs-cTnI, Siemens Diagnostics, Newark, DE). Concordance between troponin-I assays was not higher compared to troponin-I versus troponin-T assays (Abbott vs. There was no significant difference for rule-in strata (3.3%, 2.9%, and 3.7%, respectively all p = 0.687). Regarding management recommendations, the proportion of patients with similar recommendations was significantly different between the assays for both rule-out (87.2%, 73.1%, and 78.5%)Īnd observe (9.5%, 24.0%, and 17.8%, respectively p < 0.001 for both) recommendations. Significant disagreement remained when using sex-specific thresholds. The proportion of samples with an hs-cTn measurement of 99th percentile was not significantly different (7.2% vs. A total of 7.9% (n = 49 of 624) had an adjudicated diagnosis of ACS. The average age of patients was 52.8 years of age, and 39.4% were women. In secondary analyses, the authors examined the association of the different assays with diagnostic test findings (coronary angiography, perfusion imaging, and coronary computed tomography angiography). They also assessed the agreement among assays in classifying the patients as “rule-out,” “observe,” and “rule-in” using the 0/2-hour algorithm developed for each of these assays. The authors assessed the agreement between assays in their classification according to the following groups: 99th percentile. ROMICAT included patients with suspected ACS who had a negative conventional troponin measured and who were then subsequently referred for noninvasive testing. HsVista) in 624 patients with suspected ACS enrolled in the ROMICAT (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography) I and II trials. The authors measured troponin using three hs-cTn assays (Roche Diagnostics, Elecsys 2010 platform Abbott Diagnostics, ARCHITECT i2000SR Siemens Diagnostics,
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