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Emergency care
Journal Club
Evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T1
  1. Jaspreet Kaur Khaira
  1. Correspondence to Dr Jaspreet Kaur Khaira, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; jaspreet.khaira{at}ouh.nhs.uk

https://doi.org/10.1136/ebmed-2017-110830

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    Using a highly sensitive assay of serum troponin T in patients with suspected myocardial infarction might help in early diagnosis, but the method needs thorough clinical assessment before implementation.

    Summary box

    • A highly sensitive serum troponin T assay has been claimed to be useful in ruling a myocardial infarction in or out soon after presentation.

    • However, performance measures for diagnostic tests should be thought of in terms of real patients, and not taken at face value.

    • Changes in biomarker concentrations over time may be superior to single cut-off values.

    Summary of evidence

    The High Sensitivity Cardiac Troponin T Assay for Rapid Rule-out of Acute Myocardial Infarction trial was a prospective, multicentre, diagnostic study done at 12 sites, across three continents to validate the diagnostic accuracy of the troponin T 0-hour/1-hour algorithm for rule-in and rule-out of acute myocardial infarction.1

    Current troponin assays for the diagnosis of myocardial infarction usually require serial sampling between 8 and 24 hours, depending on the specific assay/local protocols. This time interval contributes to ‘rule-in’ delays, delaying treatment, and ‘rule-out’ delays, costing time, …

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    Footnotes

    • Contributors JKK presented the study at the OUH F1 Journal Club on 7 September 2017 and wrote the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.