title: Validation of an accelerated high-sensitivity troponin T assay protocol in an Australian cohort with chest pain.
abstract: OBJECTIVE
  To validate an accelerated biomarker strategy using a high-sensitivity cardiac troponin T (hs-cTnT) assay for diagnosing acute myocardial infarction (AMI) in patients presenting to the emergency department with chest pain; and to validate this strategy in combination with the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand risk stratification model.
  
  
  METHODS
  Single-centre, prospective, observational cohort study of 764 adults presenting to a tertiary hospital with symptoms of possible acute coronary syndrome between November 2008 and February 2011.
  
  
  METHODS
  AMI or cardiac death within 24 hours of presentation (primary), and major adverse cardiac events within 30 days (secondary).
  
  
  RESULTS
  An elevated hs-cTnT assay result above the 99th percentile at either the 0 h or 2 h time points had sensitivity of 96.4% (95% CI, 87.9%-99.0%), specificity of 82.6% (95% CI, 79.7%-85.2%), negative predictive value of 99.7% (95% CI, 98.8%-99.9%) and positive predictive value of 30.5% (95% CI, 24.2%-37.6%) for diagnosing AMI. Compared with a traditional 6 h cardiac troponin testing strategy, the accelerated strategy led to reclassification of risk in only two patients with adverse cardiac outcomes, with no net effect on appropriate management.
  
  
  CONCLUSIONS
  In patients presenting with chest pain, an accelerated biomarker strategy using the hs-cTnT assay performed well in the initial diagnosis of AMI. The accelerated strategy was also effective when incorporated into a comprehensive strategy of risk stratification that included clinical and demographic factors. The time saved by this approach could have a major impact on health service delivery.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12610000053022.
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. william_parsonage@health.qld.gov.au.
authors: William A
authors: WA
authors: Parsonage
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Jaimi H
authors: JH
authors: Greenslade
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Christopher J
authors: CJ
authors: Hammett
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Arvin
authors: A
authors: Lamanna
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Jillian R
authors: JR
authors: Tate
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Jacobus P
authors: JP
authors: Ungerer
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Kevin
authors: K
authors: Chu
authors: Christchurch Hospital, Christchurch, New Zealand.
authors: Martin
authors: M
authors: Than
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Anthony F T
authors: AF
authors: Brown
authors: Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors: Louise
authors: L
authors: Cullen
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D001681:Biological Assay / Q000379:methods*; D002637:Chest Pain; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T