Table 5.
Diagnostic Performance of the Proposed Algorithms
| Algorithm | hs‐cTnI | hs‐cTnT | ||
|---|---|---|---|---|
| Rule In | Rule Out | Rule In | Rule Out | |
| Sensitivity | 0.90a (0.79, 0.96) | 1.00a (0.94, 1.00) | 0.80a (0.76, 0.84) | 0.98a (0.97, 0.99) |
| Specificity | 0.87a (0.81, 0.91) | 0.51a (0.43, 0.58) | 0.78a (0.76, 0.81) | 0.24a (0.21, 0.26) |
| PPV | 0.68 (0.56, 0.78) | 0.38 (0.31, 0.47) | 0.59 (0.55, 0.63) | 0.34 (0.31, 0.36) |
| NPV | 0.96 (0.92, 0.99) | 1.00 (0.96, 1.00) | 0.91 (0.89, 0.93) | 0.97 (0.95, 0.99) |
| LR+ | 6.74 (4.63, 9.81) | 2.02 (1.75, 2.34) | 3.68 (3.26, 4.15) | 1.29 (1.25, 1.34) |
| LR− | 0.12 (0.06, 0.26) | 0.00 (0.00, NaN) | 0.26 (0.21, 0.31) | 0.07 (0.03, 0.14) |
For the rule‐in approach, patients in the “observe” category were counted as having a negative test result; for the rule‐out approach, patients in the “observe” category were counted as having a positive test result (cf. Figure 3). Values in parentheses indicate the 95% confidence intervals. Study data set: n=172 patients with CKD and suspected NSTE‐AMI; NSTE‐AMI in n=52 patients. Clinical data set: n=880 patients with CKD and suspected NSTE‐AMI; NSTE‐AMI in n=364 patients. CKD indicates chronic kidney disease; hs‐cTnI, high‐sensitivity troponin I; hs‐cTnT, high‐sensitivity troponin T; LR−, negative likelihood ratio; LR+, positive likelihood ratio; NaN, not a number; NPV, negative predictive value; NSTE‐AMI, non–ST‐segment elevation acute myocardial infarction; PPV, positive predictive value.
P<0.001 by McNemar test compared with optimized static cutoff (54 ng/L for hs‐cTnI, 50 ng/L for hs‐cTnT); McNemar test asserts significant differences between sensitivities and specificities only.