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Diagnostic value of POCT⁃cTnT for acute myocardial infarction based on symptom onset time
Received date: 2024-03-29
Online published: 2024-08-26
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 characteristics 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 difference 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.
Guojun CHEN , Tianen ZHOU , Hongfeng LIU , Li′na PENG , Jun JIANG , Chunming. XIE . Diagnostic value of POCT⁃cTnT for acute myocardial infarction based on symptom onset time[J]. The Journal of Practical Medicine, 2024 , 40(16) : 2326 -2332 . DOI: 10.3969/j.issn.1006-5725.2024.16.020
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