To evaluate the performance of sixth-generation high-sensitivity cardiac troponin T in patients with suspected non-ST-segment elevation myocardial infarction (MI).
Key Findings:
61% of 987 patients had sixth-generation troponin T concentrations < 13 ng/L at presentation.
8% of 987 patients met the primary outcome.
The sixth-generation assay had a negative predictive value of 99.9% and sensitivity of 99.4% for the primary outcome.
41% of 918 patients would be identified as low risk using the sixth-generation assay compared to 17% of 918 patients with the fifth-generation assay.
6% of 987 patients were reclassified as not having myocardial injury using the sixth-generation assay.
Interpretation:
The sixth-generation high-sensitivity cardiac troponin T assay may facilitate earlier discharge in low-risk patients by reducing the need for serial testing, as it identifies a larger proportion of patients as low risk compared to the fifth-generation assay.
Limitations:
The study was not powered to precisely estimate sensitivity, which may affect the reliability of the results.
Care was guided by current clinical assays rather than the sixth-generation assay, potentially impacting outcomes.
The cohort was predominantly White (96%) and had a low percentage of female patients (38%), which may limit generalizability.
Conclusion:
Prospective studies are needed to confirm the impact of the sixth-generation assay on reducing serial testing and facilitating earlier discharge.
Damon B. Dixon, MD, at Phoenix Children’s Cardiology, is the author to this EndoText chapter. Dr. Dixon brings nationally recognized expertise in pediatric cardiovascular risk assessment and non?invasive vascular imaging.
