Diagnostic value of POCT-cTnT for acute myocardial infarction based on symptom onset time
10.3969/j.issn.1006-5725.2024.16.020
- VernacularTitle:胸痛发作时床边即时检测心肌钙蛋白T诊断急性心肌梗死的价值
- Author:
Guo-Jun CHEN
1
;
Tianen ZHOU
;
Hongfeng LIU
;
Li'na PENG
;
Jun JIANG
;
Chunming XIE
Author Information
1. 佛山市第一人民医院(广东佛山 528000)
- Keywords:
point-of-care testing;
cardiac troponin T;
acute myocardial infarction;
chest pain
- From:
The Journal of Practical Medicine
2024;40(16):2326-2332
- CountryChina
- Language:Chinese
-
Abstract:
The sensitivity of cardiac troponin testing for diagnosing acute myocardial infarction(AMI)varies over time from chest pain onset.This study aimed to determine the diagnostic performance of point-of-care testing cardiac troponin T(POCT-cTnT)at different time intervals post-symptom onset to refine rapid rule-out approaches for AMI.Methods This retrospective study included 6,024 patients presenting with chest pain from January 2018 to December 2022.POCT-cTnT and central lab cTnI levels were measured on admission.Receiver operating charac-teristics analysis stratified by time windows assessed the accuracy of POCT-cTnT for diagnosing AMI.Results The overall AUC of POCT-cTnT for diagnosing AMI was 0.826(95%CI:0.816～0.836),with a sensitivity of 72.81%and a specificity of 86.26%.According to the time intervals of chest pain onset(＜3 hours,3～6 hours,6～12 hours,12～24 hours,24～72 hours,and≥72 hours),the AUC values for groups after 6～12 hours were 0.918,0.928,0.920 and 0.908,respectively,with no statistically significant difference(P＞0.05),but all were higher than the groups within 6 hours(P＜0.001).According to the time of chest pain onset,the AUC for the≥8h group was 0.921,with a negative predictive value(NPV)of 98.1%and a negative likelihood ratio(-LR)of 0.11.Its AUC was higher than those of the≥3 h,≥2 h,≥1 h,and overall groups(P＜0.05),but there was no statistically significant differ-ence compared with the groups after≥4 h(P＞0.05).Conclusions Chest pain onset time has a certain impact on the performance of a single POCT-cTnT test for diagnosing AMI.The duration from chest pain onset to hospital admission combined with POCT-cTnT test may improve the reliability in diagnosing AMI.Specifically,a single POCT-cTnT test at four hours after chest pain onset,especially eight hours after chest pain onset,can diagnose or exclude AMI.
