• Chien-Chang Lee, Sih-Shiang Huang, Yee Hui Yeo, Yi-Ting Hou, James Yeongjun Park, Kenji Inoue, and Wan-Ting Hsu.
• Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Data Science Research Group, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: cclee100@gmail.com.
• Am J Emerg Med. 2020 Jul 1; 38 (7): 1402-1407.

ObjectivesCardiovascular disease is the leading cause of mortality and morbidity. Serial troponin tests have been endorsed as essential diagnostic steps to rule out/-in acute myocardial infarction (AMI), and hs-cTn assays have shown promise in enhancing the accuracy and efficiency of AMI diagnosis in the emergency department (ED).MethodsA systematic review and meta-analysis of diagnostic test accuracy studies were conducted to compare the diagnostic performance of various accelerated diagnostic algorithms of hs-cTn assays for patients with symptoms of AMI. Random-effects bivariate meta-analysis was conducted to estimate the summary sensitivity, specificity, likelihood ratios, and area under receiver operating characteristic curve.ResultsIn the systematic review consisting of 56 studies and 67,945 patients, both hs-cTnT and hs-cTnI-based 0-, 1-, 2- and 0-1 h algorithms showed a pooled sensitivity >90%. The hs-cTnI-based algorithm showed a pooled specificity >80%. The hs-cTnT-based algorithms had a specificity of 68% for the 0-h algorithm and of around 80% for the 1-, 2-, and 0-1 h algorithms. The heterogeneities of all diagnostic algorithms were mild (I2 < 50%).ConclusionBoth hs-cTnI- and hs-cTnT-based accelerated diagnostic algorithms have high sensitivities but moderate specificities for early diagnosis of AMI. Overall, hs-cTnI-based algorithms have slightly higher specificities in early diagnosis of AMI. For patients presenting ED with typical symptoms, the use of hs-cTnT or hs-cTnI assays at the 99th percentile may help identify patients with low risk for AMI and promote early discharge from the ED.Copyright © 2019 Elsevier Inc. All rights reserved.

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