Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection: A Collaborative Meta-analysis

Journal Club Summary

Methodology Score: 3.5/5               
Usefulness Score: 3.5/5

Question and Methods: This meta-analysis included prospective studies to assess the ability of a single negative hs-cTnT and non-ischemic ECG to identify patients at low risk for AMI.

Findings: The results of 11 studies were pooled, resulting in a pooled sensitivity of 98.7% (95% CI 96.6-99.5%) No low-risk patients died.

Limitations: High risk of bias; heterogeneity; 7 potential eligible articles excluded;

Interpretation: A single negative hs-cTnT, non-ischemic ECG and reassuring clinical gestalt could potentially be used to safely discharge patients. It might lead to increased admission rate/cardiology consultations.

By: Dr. Rosa Ramaekers 

Pickering JW, et al. Ann Intern Med. 2017 May 16;166(10):715-724. 

EDITORIAL:

The Single High-Sensitivity Serum Cardiac Troponin T Level: A Significant Advance for Chest Pain Pathways? Kussmaul Iii WG. Ann Intern Med. 2017 May 16;166(10):751. 

Epi lesson

Individual-Patient vs. Aggregate-Data Meta-Analyses

Meta-analysis of individual-patient data can have statistical and clinical advantages over the use of reported aggregate results. For e.g., aggregate results may be missing measures of spread, be subject to publication bias, or be presented differently between studies (e.g. OR vs. RR). Access to individual-patient data may help standardization of analyses across studies, provide access to more outcomes, and possibly lead to more reliable/different results compared to aggregate-data meta-analyses.

By: Dr. Christian Vaillancourt