New High-Sensitivity Cardiac Troponin Test Quickly Rules Out Heart Attack

Patients arriving at an emergency department with symptoms like chest or arm pain, indicative of a potential heart attack, often prefer the comfort of home over a hospital bed—especially if they can be assured they are not experiencing a heart attack. However, it can be challenging for clinicians to ascertain whether such pain is heart-related. Now, new research indicates that up to 60% of individuals visiting emergency departments across the world with heart attack symptoms could be safely discharged, many at earlier stages, using a new high-sensitivity cardiac troponin test.

Mindray’s (Shenzhen, China) cardiac troponin I assay enables clinical teams to measure troponin I proteins released into the bloodstream during heart attacks or when the heart is damaged. This assay, noted for its high precision and sensitivity for both men and women, was the subject of a study conducted by cardiac biomarker specialists at Hennepin Healthcare’s Hennepin County Medical Center (Minneapolis, MN, USA). Initial findings suggest significant clinical applications that could reduce the strain on busy emergency departments. The test not only matched or exceeded the performance of existing assays but also showed potential for helping clinical teams rule out many patients with heart attack symptoms at an early stage.

In a study involving over 1,500 patients presenting with symptoms like chest pain, arm pain, or jaw pain, researchers discovered that 15% of those who arrived early could be ruled out for a heart attack based on a single blood test taken upon arrival. Typically, most assays of this type require an initial blood sample as a baseline measurement, followed by another test for cardiac troponin I two hours later. By combining this approach and applying a second blood sample to the Mindray assay after two hours, researchers found that an additional 30-40% of the remaining participants could also be safely ruled out, with a less than 1% likelihood of an adverse event within the following 30 days.

The exceptional precision in measuring cardiac troponin I with the Mindray assay allowed for further patients to be ruled out. Ultimately, researchers identified that 60% of patients arriving at the emergency department with symptoms akin to a heart attack could safely return home. Besides ruling individuals out, the findings suggest that the assay can effectively determine, with a high positive predictive value of approximately 70%, when patients are indeed experiencing a heart attack, aiding clinical decisions for immediate admissions. The preliminary results are currently under peer review, and further investigations are underway. Future research into high-sensitivity cardiac troponin I and T assays aims to enhance clinicians' understanding of whether myocardial injuries are chronic or acute, ultimately guiding them toward the most effective treatments and therapies for patients.

“Our preliminary findings around Mindray’s high-sensitivity troponin I test are exciting for emergency medicine – with multiple ways this could be built into algorithmic clinical practice to help avoid overcrowding and enhance triage safety,” said Professor Fred Apple, the study’s principal investigator and a medical director in laboratory medicine at Hennepin Healthcare. “That it is so incredibly precise and analytically very sensitive to measure low cardiac troponin concentrations, opens new and unique possibilities when patients present early to an emergency department, so that clinicians can make informed decisions to send people home, without concern.”

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