Current Evidence for the Use of High-Sensitivity Troponin Assays in the Emergency Department

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Árnadóttir Á, Vestergaard KR, Pallisgaard J, Sölétormos G, Steffensen R, Goetze JP, Iversen K. High-sensitivity cardiac troponin T is superior to troponin I in the prediction of mortality in patients without acute coronary syndrome. Int J Cardiol. 2018;259:186–91. https://doi.org/10.1016/j.ijcard.2018.01.131. Epub 2018 Feb 4 PMID: 29477263.

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Carlton EW, Cullen L, Than M, Gamble J, Khattab A, Greaves K. A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin. Heart. 2015;101(13):1041–6. https://doi.org/10.1136/heartjnl-2014-307288. Epub 2015 Feb 17. PMID: 25691511; PMCID: PMC4484040.

• Chapman AR, Lee KK, McAllister DA, Cullen L, Greenslade JH, Parsonage W, Worster A, Kavsak PA, Blankenberg S, Neumann J, Sörensen NA, Westermann D, Buijs MM, Verdel GJE, Pickering JW, Than MP, Twerenbold R, Badertscher P, Sabti Z, Mueller C, Anand A, Adamson P, Strachan FE, Ferry A, Sandeman D, Gray A, Body R, Keevil B, Carlton E, Greaves K, Korley FK, Metkus TS, Sandoval Y, Apple FS, Newby DE, Shah ASV, Mills NL. Association of high-sensitivity cardiac troponin I concentration with cardiac outcomes in patients with suspected acute coronary syndrome. JAMA. 2017;318(19):1913–24. https://doi.org/10.1001/jama.2017.17488. Erratum in: JAMA. 2018;319(11):1168. Soerensen NA [corrected to Sorensen NA]. PMID: 29127948; PMCID: PMC5710293. Meta-analysis of 22,457 patient from 9 different countries sought out the optimal hs-cTnI concentration at presentation to qualify patients as low risk for acute coronary syndrome.

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Body R, Carley S, McDowell G, Jaffe AS, France M, Cruickshank K, Wibberley C, Nuttall M, Mackway-Jones K. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a high-sensitivity assay. J Am Coll Cardiol. 2011;58(13):1332–9. https://doi.org/10.1016/j.jacc.2011.06.026. Erratum in: J Am Coll Cardiol. 2012;60(12):1122. PMID: 21920261.

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Abbott. Troponin. 2023. Available at https://www.corelaboratory.abbott/us/en/offerings/segments/cardiac/troponin.html#isi. Accessed 20 Nov 2023.

Neumann JT, Sörensen NA, Ojeda F, Schwemer T, Lehmacher J, Gönner S, Jarsetz N, Keller T, Schaefer S, Renné T, Landmesser U, Clemmensen P, Makarova N, Schnabel RB, Zeller T, Karakas M, Pickering JW, Than M, Parsonage W, Greenslade J, Cullen L, Westermann D, Blankenberg S. Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I. Clin Chem. 2017;63(1):394–402. https://doi.org/10.1373/clinchem.2016.262659. Epub 2016 Nov 30 PMID: 27903616.

Sandoval Y, Smith SW, Shah AS, Anand A, Chapman AR, Love SA, Schulz K, Cao J, Mills NL, Apple FS. Rapid rule-out of acute myocardial injury using a single high-sensitivity cardiac troponin I measurement. Clin Chem. 2017;63(1):369–76. https://doi.org/10.1373/clinchem.2016.264523. Epub 2016 Nov 3 PMID: 27811203.

Beckman Coulter. Access high sensitivity troponin I assay. 2023. Available at https://www.beckmancoulter.com/products/immunoassay/access-hstni#/overview. Accessed 20 Nov 2023.

Beckman Coulter. Access immunoassay systems instructions for use. 2021. Available at https://www.beckmancoulter.com/download/file/phxC09449G-EN_US/C09449G?type=pdf. Accessed 20 Nov 2023.

Kim S, Yoo SJ, Kim J. Evaluation of the new Beckman Coulter Access hsTnI: 99th percentile upper reference limits according to age and sex in the Korean population. Clin Biochem. 2020;79:48–53. https://doi.org/10.1016/j.clinbiochem.2020.02.005. Epub 2020 Feb 12 PMID: 32059836.

Cook B, McCord J, Hudson M, Al-Darzi W, Moyer M, Jacobsen G, Nowak R. Baseline high sensitivity cardiac troponin I level below limit of quantitation rules out acute myocardial infarction in the emergency department. Crit Pathw Cardiol. 2021;20(1):4–9. https://doi.org/10.1097/HPC.0000000000000230. PMID: 32639243; PMCID: PMC7899745.

Siemens Healthineers. Advia centaur high-sensitivity troponin I assay. 2018. Available at https://cdn0.scrvt.com/39b415fb07de4d9656c7b516d8e2d907/1800000006781448/7dcea7abaa21/30-18-12862-01-76_ADVIA_Cntr_TNIH_Glb_SS_Fnl_1800000006781448.pdf. Accessed 20 Nov 2023.

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Shah ASV, Anand A, Strachan FE, Ferry AV, Lee KK, Chapman AR, Sandeman D, Stables CL, Adamson PD, Andrews JPM, Anwar MS, Hung J, Moss AJ, O'Brien R, Berry C, Findlay I, Walker S, Cruickshank A, Reid A, Gray A, Collinson PO, Apple FS, McAllister DA, Maguire D, Fox KAA, Newby DE, Tuck C, Harkess R, Parker RA, Keerie C, Weir CJ, Mills NL, High-STEACS Investigators. High-sensitivity troponin in the evaluation of patients with suspected acute coronary syndrome: a stepped-wedge, cluster-randomised controlled trial. Lancet. 2018;392(10151):919–28. https://doi.org/10.1016/S0140-6736(18)31923-8. Epub 2018 Aug 28. PMID: 30170853; PMCID: PMC6137538.

• Anand A, Lee KK, Chapman AR, Ferry AV, Adamson PD, Strachan FE, Berry C, Findlay I, Cruikshank A, Reid A, Collinson PO, Apple FS, McAllister DA, Maguire D, Fox KAA, Newby DE, Tuck C, Harkess R, Keerie C, Weir CJ, Parker RA, Gray A, Shah ASV, Mills NL, HiSTORIC Investigators†. High-sensitivity cardiac troponin on presentation to rule out myocardial infarction: a stepped-wedge cluster randomized controlled trial. Circulation. 2021;143(23):2214–24. https://doi.org/10.1161/CIRCULATIONAHA.120.052380. Epub 2021 Mar 23. PMID: 33752439; PMCID: PMC8177493. Randomized control trial including emergency departments of 7 acute care hospitals enrolling 31,492 patients to demonstrate safety and efficacy of early rule-out pathways for patients presenting with suspected acute coronary syndromes.

Apple FS, Fantz CR, Collinson PO; IFCC committee on clinical application of cardiac bio-markers. implementation of high-sensitivity and point-of-care cardiac troponin assays into practice: some different thoughts. Clin Chem. 2021:67(1):70–8. https://doi.org/10.1093/clinchem/hvaa264. PMID: 33279984; PMCID: PMC7799201.

Stepinska J, Lettino M, Ahrens I, Bueno H, Garcia-Castrillo L, Khoury A, Lancellotti P, Mueller C, Muenzel T, Oleksiak A, Petrino R, Guimenez MR, Zahger D, Vrints CJ, Halvorsen S, de Maria E, Lip GY, Rossini R, Claeys M, Huber K. Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care. 2020;9(1):76–89. https://doi.org/10.1177/2048872619885346. Epub 2020 Jan 20. PMID: 31958018.

Chapman AR, Hesse K, Andrews J, Lee KK, Anand A, Shah ASV, Sandeman D, Ferry AV, Jameson J, Piya S, Stewart S, Marshall L, Strachan FE, Gray A, Newby DE, Mills NL. High-sensitivity cardiac troponin I and clinical risk scores in patients with suspected acute coronary syndrome. Circulation. 2018;138(16):1654–65. https://doi.org/10.1161/CIRCULATIONAHA.118.036426. PMID: 30354460; PMCID: PMC6200389.

•• Writing Committee; Kontos MC, de Lemos JA, Deitelzweig SB, Diercks DB, Gore MO, Hess EP, McCarthy CP, McCord JK, Musey PI Jr, Villines TC, Wright LJ. 2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;80(20):1925–60. https://doi.org/10.1016/j.jacc.2022.08.750. Epub 2022 Oct 11. PMID: 36241466. 2022 American College of Cardiology guidelines for the evaluation of chest pain in the emergency department provide a comprehensive review of current definitions, findings, and recommended evaluation of chest pain.

• Gulati M, Levy PD, Mukherjee D, Amsterdam E, Bhatt DL, Birtcher KK, Blankstein R, Boyd J, Bullock-Palmer RP, Conejo T, Diercks DB, Gentile F, Greenwood JP, Hess EP, Hollenberg SM, Jaber WA, Jneid H, Joglar JA, Morrow DA, O'Connor RE, Ross MA, Shaw LJ. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021;144(22):e368–454. https://doi.org/10.1161/CIR.0000000000001029. Epub 2021 Oct 28. Erratum in: Circulation. 2021;144(22):e455. PMID: 34709879. 2021 guidelines for diagnosis of chest pain including comprehensive literature search provide an evidence-based approach to risk stratification and diagnostic workup for the evaluation of chest pain.

Lowry MTH, Anand A, Mills NL. Implementing an early rule-out pathway for acute myocardial infarction in clinical practice. Heart. 2021;107(23):1912–9. https://doi.org/10.1136/heartjnl-2019-316242. Epub 2021 Sep 3. PMID: 34479874; PMCID: PMC8600603.

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Backus BE, Six AJ, Kelder JC, Bosschaert MA, Mast EG, Mosterd A, Veldkamp RF, Wardeh AJ, Tio R, Braam R, Monnink SH, van Tooren R, Mast TP, van den Akker F, Cramer MJ, Poldervaart JM, Hoes AW, Doevendans PA. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol. 2013;168(3):2153–8. https://doi.org/10.1016/j.ijcard.2013.01.255. Epub 2013 Mar 7 PMID: 23465250.

Carlton EW, Khattab A, Greaves K. Identifying patients suitable for discharge after a single-presentation high-sensitivity troponin result: a comparison of five established risk scores and two high-sensitivity assays. Ann Emerg Med. 2015;66(6):635–45.e1. https://doi.org/10.1016/j.annemergmed.2015.07.006. Epub 2015 Aug 7 PMID: 26260100.

Jaeger C, Wildi K, Twerenbold R, Reichlin T, Rubini Gimenez M, Neuhaus JD, Grimm K, Boeddinghaus J, Hillinger P, Nestelberger T, Singeisen H, Gugala M, Pretre G, Puelacher C, Wagener M, Honegger U, Schumacher C, Moreno Weidmann Z, Kreutzinger P, Krivoshei L, Freese M, Stelzig C, Dietsche S, Ernst S, Rentsch K, Osswald S, Mueller C. One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. Am Heart J. 2016;171(1):92–102.e1–5. https://doi.org/10.1016/j.ahj.2015.07.022. Epub 2015 Jul 26. PMID: 26699605.

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