Consequences of high-sensitivity troponin T testing applied in a primary care population with chest pain compared with a commercially available point-of-care troponin T analysis: an observational prospective study

BMC Research Notes

Staffan Nilsson⁴  Karin Festin¹  Eva Landberg³  Jan-Erik Karlsson¹  Per O Andersson² 

[1] Department of Medical and Health Sciences, Linköping University, Linköping, SE-581 83, Sweden;Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden;Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;Primary Health Care and Department of Medical and Health Sciences, Linköping University, Norrköping, Sweden

关键词: Point-of-care testing;    Troponin T;    Chest pain;    Acute coronary syndrome;    Primary health care;   

Others  :  1232445
DOI  :  10.1186/s13104-015-1174-0

 received in 2015-04-08, accepted in 2015-05-18,  发布年份 2015

【 摘 要 】

Background

There is a demand for a highly sensitive and specific point-of care test to detect acute myocardial infarction (AMI). It is unclear if a high-sensitivity troponin assay will have enough discriminative power to become a decision support in primary care. The aim of this study was to evaluate a high-sensitivity troponin T assay performed in three primary health care centres in southeast Sweden and to compare the outcome with a point-of-care troponin T test.

Methods

This study included 115 patients who consulted their general practitioner for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue in the last 7 days. Troponin T was analysed by a point-of-care test and a high-sensitivity method together with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and creatinine. All patients were checked for AMI or unstable angina (UA) within 30 days of study enrolment. Univariate and multivariate logistic regression was carried out to examine possible connections between troponin T ≥ 15 ng/L, clinical variables and laboratory findings at baseline. In addition, 21 patients with troponin T ≥ 15 ng/L and no signs of AMI or UA were followed up for 2–3 years.

Results

Three patients were diagnosed with AMI and three with UA. At the ≥ 15 ng/L cut-off, the troponin T method had 100% sensitivity, 75% specificity for AMI and a positive predictive value of 10%. The troponin T point-of-care test missed one case of AMI and the detection limit was 50 ng/L. Troponin T ≥ 15 ng/L was correlated to age ≥65 years (odds ratio (OR), 10.9 95% CI 2.28–51.8) and NT-proBNP in accordance with heart failure (OR 8.62 95% CI 1.61–46.1). Fourteen of the 21 patients, without signs of AMI or UA at baseline, still had increased troponin T at follow-up after 2–3 years.

Conclusions

A high-sensitivity troponin T assay could become useful in primary care as a point-of-care test for patients <65 years. For patients older than 65–70 years, a higher decision limit than ≥15 ng/L should be considered and used in conjunction with clinical parameters and possibly with NT-proBNP.

【 授权许可】

   
2015 Andersson et al.

【 图 表 】

Figure1.

【 参考文献 】

• [1]Verdon F, Burnand B, Herzig L, Junod M, Pecoud A, Favrat B: Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract 2007, 8:51. BioMed Central Full Text
• [2]Nilsson S, Scheike M, Engblom D, Karlsson LG, Molstad S, Akerlind I, et al.: Chest pain and ischaemic heart disease in primary care. Br J Gen Pract 2003, 53(490):378-382.
• [3]Svavarsdottir AE, Jonasson MR, Gudmundsson GH, Fjeldsted K: Chest pain in family practice. Diagnosis and long-term outcome in a community setting [published erratum appears in Can Fam Physician 1996 Sep; 42:1672]. Can Fam Physician 1996, 42:1122-1128.
• [4]Bosner S, Becker A, Haasenritter J, Abu Hani M, Keller H, Sonnichsen AC, et al.: Chest pain in primary care: epidemiology and pre-work-up probabilities. Eur J Gen Pract 2009, 15(3):141-146.
• [5]Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD: Third universal definition of myocardial infarction. Circulation 2012, 126(16):2020-2035.
• [6]Aldous S, Gent P, McGeoch G, Nicholson D: The use of troponin in general practice. NZ Med J 2012, 125(1357):36-43.
• [7]Law K, Elley R, Tietjens J, Mann S: Troponin testing for chest pain in primary healthcare: a survey of its use by general practitioners in New Zealand. NZ Med J 2006, 119(1238):U2082.
• [8]Mann S, Tietjens J, Law K, Elley R: Troponin testing for chest pain in primary healthcare: a New Zealand audit. NZ Med J 2006, 119(1238):U2083.
• [9]Planer D, Leibowitz D, Paltiel O, Boukhobza R, Lotan C, Weiss TA: The diagnostic value of troponin T testing in the community setting. Int J Cardiol 2006, 107(3):369-375.
• [10]Tomonaga Y, Gutzwiller F, Luscher TF, Riesen WF, Hug M, Diemand A, et al.: Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial. BMC Fam Pract 2011, 12:12. BioMed Central Full Text
• [11]Nilsson S, Andersson PO, Borgquist L, Grodzinsky E, Janzon M, Point-of-Care Kvick M, Troponin T, et al.: Point-of-Care troponin T testing in the management of patients with chest pain in the Swedish Primary Care. Int J Family Med 2013.
• [12]Hammarsten O, Fu M, Sigurjonsdottir R, Petzold M, Said L, Landin-Wilhelmsen K, et al.: Troponin T percentiles from a random population sample, emergency room patients and patients with myocardial infarction. Clin Chem 2012, 58(3):628-637.
• [13]Knebel F, Spethmann S, Schattke S, Dreger H, Schroeckh S, Schimke I, et al.: Exercise-induced changes of left ventricular diastolic function in postmenopausal amateur marathon runners: assessment by echocardiography and cardiac biomarkers. Eur J Prev Cardiol 2012.
• [14]Saenger AK, Beyrau R, Braun S, Cooray R, Dolci A, Freidank H, et al.: Multicenter analytical evaluation of a high-sensitivity troponin T assay. Clin Chim Acta 2011, 412(9–10):748-754.
• [15]Apple FS, Jaffe AS: Clinical implications of a recent adjustment to the high-sensitivity cardiac troponin T assay: user beware. Clin Chem 2012, 58(11):1599-1600.
• [16]Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al.: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006, 145(4):247-254.
• [17]Rustad P, Felding P, Franzson L, Kairisto V, Lahti A, Martensson A, et al.: The Nordic reference interval project 2000: recommended reference intervals for 25 common biochemical properties. Scand J Clin Lab Invest 2004, 64(4):271-284.
• [18]Maisel A, Mueller C, Adams K, Anker SD, Aspromonte N, Cleland JG, et al.: State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail 2008, 10(9):824-839.
• [19]Eggers KM, Venge P, Lindahl B: High-sensitive cardiac troponin T outperforms novel diagnostic biomarkers in patients with acute chest pain. Clin Chim Acta 2012, 413(13–14):1135-1140.
• [20]Mansour M, Clark L, Scott T, Worster A, Kavsak PA: Considerations for establishing a reference interval for elderly individuals in the emergency department with the high-sensitivity cardiac troponin T assay. Clin Chim Acta 2013, 421:85-86.
• [21]Menacer S, Claessens YE, Meune C, Elfassi Y, Wakim C, Gauthier L, et al.: Reference range values of troponin measured by sensitive assays in elderly patients without any cardiac signs/symptoms. Clin Chim Acta 2013, 417:45-47.
• [22]Agvall B, Borgquist L, Foldevi M, Dahlstrom U: Cost of heart failure in Swedish primary healthcare. Scand J Prim Health Care 2005, 23(4):227-232.
• [23]Bruins Slot MH, van der Heijden GJ, Stelpstra SD, Hoes AW, Rutten FH: Point-of-care tests in suspected acute myocardial infarction: a systematic review. Int J Cardiol 2013, 168(6):5355-5362.
• [24]Palamalai V, Murakami MM, Apple FS: Diagnostic performance of four point of care cardiac troponin I assays to rule in and rule out acute myocardial infarction. Clin Biochem 2013, 46(16–17):1631-1635.
• [25]Lee W, Jung J, Hahn YK, Kim SK, Lee Y, Lee J, et al.: A centrifugally actuated point-of-care testing system for the surface acoustic wave immunosensing of cardiac troponin I. Analyst 2013, 138(9):2558-2566.
• [26]Zhang J, Kruss S, Hilmer AJ, Shimizu S, Schmois Z, De La Cruz F, et al.: A rapid, direct, quantitative, and label-free detector of cardiac biomarker troponin T using near-infrared fluorescent single-walled carbon nanotube sensors. Adv Healthc Mater 2013, 21(10):201300033.
• [27]Parwani AS, Boldt LH, Huemer M, Wutzler A, Blaschke D, Rolf S, et al.: Atrial fibrillation-induced cardiac troponin I release. Int J Cardiol 2013, 168(3):2734-2737.
• [28]Anegawa T, Kai H, Adachi H, Hirai Y, Enomoto M, Fukami A, et al.: High-sensitive troponin T is associated with atrial fibrillation in a general population. Int J Cardiol 2012, 156(1):98-100.
• [29]Maw T, Fried L: Chronic kidney disease in the elderly. Clin Geriatr Med 2013, 29(3):611-624.