Facial reconstruction

Search LJMU Research Online

Browse Repository | Browse E-Theses

Diagnostic accuracy of the T-MACS decision aid with a contemporary point-of-care troponin assay.

Body, R, Almashali, M, Morris, N, Moss, P, Jarman, H, Appelboam, A, Parris, R, Chan, L, Walker, A, Harrison, M, Wootten, A and McDowell, G (2019) Diagnostic accuracy of the T-MACS decision aid with a contemporary point-of-care troponin assay. Heart, 105 (10). pp. 768-774. ISSN 1355-6037

[img]
Preview
Text
BEST APOC manuscript R2 - As accepted.pdf - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

Download (231kB) | Preview

Abstract

OBJECTIVES: The rapid turnaround time of point-of-care (POC) cardiac troponin (cTn) assays is highly attractive for crowded emergency departments (EDs). We evaluated the diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a POC cTn assay. METHODS: In a prospective diagnostic accuracy study at eight EDs, we included patients with suspected acute coronary syndromes (ACS). Blood drawn on arrival and 3 hours later was analysed for POC cTnI (i-Stat, Abbott Point of Care). The primary outcome was a diagnosis of ACS, which included both an adjudicated diagnosis of acute myocardial infarction (AMI) based on serial laboratory cTn testing and major adverse cardiac events (death, AMI or coronary revascularisation) within 30 days. RESULTS: Of 716 patients included, 105 (14.7%) had ACS. Using serial POC cTnI concentrations over 3 hours could have 'ruled out' ACS in 198 (31.2%) patients with a sensitivity of 99.0% (95% CI 94.4% to 100.0%) and negative predictive value 99.5% (95% CI 96.5% to 99.9%). No AMIs were missed. T-MACS 'ruled in' ACS for 65 (10.4%) patients with a positive predictive value of 91.2% (95% CI 82.1% to 95.9%) and specificity 98.9% (97.6% to 99.6%). CONCLUSION: With a POC cTnI assay, T-MACS could 'rule out' ACS for approximately one-third of patients within 3 hours while 'ruling in' ACS for another 10%. The rapid turnaround time and portability of the POC assay make this an attractive pathway for use in crowded EDs or urgent care centres. Future work should also evaluate use in the prehospital environment.

Item Type: Article
Uncontrolled Keywords: 1102 Cardiorespiratory Medicine and Haematology
Subjects: R Medicine > RM Therapeutics. Pharmacology
Divisions: Pharmacy & Biomolecular Sciences
Publisher: BMJ Publishing Group
Related URLs:
Date Deposited: 06 Apr 2020 08:39
Last Modified: 06 Apr 2020 08:45
DOI or Identification number: 10.1136/heartjnl-2018-313825
URI: http://researchonline.ljmu.ac.uk/id/eprint/12652

Actions (login required)

View Item View Item