Serial high-sensitivity cardiac troponin testing for the diagnosis of myocardial infarction: a scoping review

Hirotaka Ohtake; Teruhiko Terasawa; Zhivko Zhelev; Mitsunaga Iwata; Morwenna Rogers; Jaime L Peters; Chris Hyde

doi:10.1136/bmjopen-2022-066429

Serial high-sensitivity cardiac troponin testing for the diagnosis of myocardial infarction: a scoping review

BMJ Open. 2022 Nov 22;12(11):e066429. doi: 10.1136/bmjopen-2022-066429.

Authors

Hirotaka Ohtake¹, Teruhiko Terasawa², Zhivko Zhelev³, Mitsunaga Iwata¹, Morwenna Rogers⁴, Jaime L Peters^{5

5}, Chris Hyde⁶

Affiliations

¹ Department of Emergency and General Internal Medicine, Fujita Health University, Toyoake, Aichi, Japan.
² Department of Emergency and General Internal Medicine, Fujita Health University, Toyoake, Aichi, Japan terasawa@fujita-hu.ac.jp.
³ University of Exeter Medical School, University of Exeter, Exeter, UK.
⁴ NIHR CLAHRC South West Peninsula, University of Exeter, Exeter, UK.
⁵ Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK.
⁶ Exeter Test Group, University of Exeter, Exeter, UK.

Abstract

Objectives: We aimed to assess the diversity and practices of existing studies on several assays and algorithms for serial measurements of high-sensitivity cardiac troponin (hs-cTn) for risk stratification and the diagnosis of myocardial infarction (MI) and 30-day outcomes in patients suspected of having non-ST-segment elevation MI (NSTEMI).

Methods: We searched multiple databases including MEDLINE, EMBASE, Science Citation Index, the Cochrane Database of Systematic Reviews and the CENTRAL databases for studies published between January 2006 and November 2021. Studies that assessed the diagnostic accuracy of serial hs-cTn testing in patients suspected of having NSTEMI in the emergency department (ED) were eligible. Data were analysed using the scoping review method.

Results: We included 86 publications, mainly from research centres in Europe, North America and Australasia. Two hs-cTn assays, manufactured by Abbott (43/86) and Roche (53/86), dominated the evaluations. The studies most commonly measured the concentrations of hs-cTn at two time points, at presentation and a few hours thereafter, to assess the two-strata or three-strata algorithm for diagnosing or ruling out MI. Although data from 83 studies (97%) were prospectively collected, 0%-90% of the eligible patients were excluded from the analysis due to missing blood samples or the lack of a final diagnosis in 53 studies (62%) that reported relevant data. Only 19 studies (22%) reported on head-to-head comparisons of alternative assays.

Conclusion: Evidence on the accuracy of serial hs-cTn testing was largely derived from selected research institutions and relied on two specific assays. The proportions of the eligible patients excluded from the study raise concerns about directly applying the study findings to clinical practice in frontline EDs.

Prospero registration number: CRD42018106379.

Keywords: Cardiology; Coronary heart disease; Ischaemic heart disease; Myocardial infarction.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Humans
Myocardial Infarction* / diagnosis
Non-ST Elevated Myocardial Infarction* / diagnosis
Systematic Reviews as Topic
Troponin

Substances

Troponin