To the Editor:
In the recent article in Circulation Reports, entitled “Performance of the 0-Hour/1-Hour Algorithm for Diagnosing Myocardial Infarction in Patients With Chest Pain in the Emergency Department – A Systematic Review and Meta-Analysis”, Nomura et al.1 conducted a meta-analysis of the diagnostic performance of the 0-hour/1-hour algorithm and reported results for high-sensitivity troponin (hs-Tn) I and T assays. We are concerned that there are some issues with hs-Tn assays.
First, the authors included the results of 6 studies on hs-TnI assay in their meta-analysis; 5 of these studies used the Abbott ARCHITECT hs-TnI assay and 1 used the Siemens Dimension Vista 1500 hs-TnI assay. However, hs-TnI assays have different cut-off values and diagnostic performance, and the diagnostic performance of the 0-hour/1-hour algorithms is assay specific. Therefore, a meta-analysis of studies using different hs-TnI assays is probably incorrect and the results of different hs-TnI assays should be reported separately.
Second, the authors stated that 2 studies used a fourth-generation hs-TnT assay for the 0-hour/1-hour algorithm, but the fourth-generation troponin T assay is not an hs-Tn assay and therefore cannot be applied to the 0-hour/1-hour algorithm.2 It is probably an error for the fifth-generation troponin T.
Disclosures
M.T. has received non-financial support for research from Abbott Diagnostics Medical, Roche Diagnostics, and Siemens Healthcare Diagnostics. All other authors have no conflict of interest to declare.
Masafumi Tada, MD
Taku Ichihashi, MD, PhD
Kenta Hachiya, MD, PhD
Kentaro Yamada, MD, PhD
Tomoaki Saeki, MD, PhD
Department of Emergency Medicine, Neurology (M.T.), Department of Cardiology (T.I., K.H., T.S.), Department of Neurology (K.Y.), Nagoya City University East Medical Center, Nagoya; Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto (M.T.), Japan
References
- 1. Nomura O, Hashiba K, Kikuchi M, Kojima S, Hanada H, Mano T, et al.. Performance of the 0-hour/1-hour algorithm for diagnosing myocardial infarction in patients with chest pain in the emergency department: A systematic review and meta-analysis. Circ Rep 2022; 4: 241–247. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Apple FS, Collinson PO; IFCC Task Force on Clinical Applications of Cardiac Biomarkers.. Analytical characteristics of high-sensitivity cardiac troponin assays. Clin Chem 2012; 58: 54–61. [DOI] [PubMed] [Google Scholar]