Written by Clay Smith
The new tool, Compass MI, allows you to choose high-sensitivity troponin i or t (hsTni or hsTnt), initial cutoff, early/late delta troponin, and calculates the diagnostic performance you can expect.
Why does this matter?
The performance of hsTni and hsTnt is slightly different. Also, the time it is drawn and time interval of serial sampling makes a difference. How should an organization trying to add this test use hsTn? What will the diagnostic accuracy be at various cutoffs?
This was a multicenter study of 22,651 patients presenting to the ED with possible MI who had either hsTni or hsTnt drawn at various times. The diagnostic performance of a risk assessment tool was derived, internally validated, and externally validated. The gist is that the lower the hsTn on arrival and the lower the delta hsTn on serial sampling, the lower the risk of MI or death in the ED or at 30 days. But it depends on the assay, cutoff, and delta timing. And there are almost infinite combinations. To solve this, they made a web calculator that allows you to choose these variables and calculates the diagnostic performance based on your selections. It is a great tool called Compass MI. See it in action here. Here are some screenshots.
Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. N Engl J Med. 2019 Jun 27;380(26):2529-2540. doi: 10.1056/NEJMoa1803377.
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Reviewed by Thomas Davis