{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T15:59:29Z","timestamp":1792598369903,"version":"4.5.0"},"reference-count":318,"publisher":"National Institute for Health and Care Research","issue":"33","license":[{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/non-commercial-government-licence\/non-commercial-government-licence.htm"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["NIHR130462"],"award-info":[{"award-number":["NIHR130462"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n Early diagnosis of acute myocardial infarction is important, but only 20% of emergency admissions for chest pain will actually have an acute myocardial infarction. High-sensitivity cardiac troponin assays may allow rapid rule out of myocardial infarction and avoid unnecessary hospital admissions.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To assess the clinical effectiveness and cost-effectiveness of high-sensitivity cardiac troponin assays for the management of adults presenting with acute chest pain, in particular for the early rule-out of acute myocardial infarction.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Sixteen databases were searched up to September 2019. Review methods followed published guidelines. Studies were assessed for quality using appropriate risk-of-bias tools. The bivariate model was used to estimate summary sensitivity and specificity for meta-analyses involving four or more studies; otherwise, random-effects logistic regression was used. The health economic analysis considered the long-term costs and quality-adjusted life-years associated with different troponin testing methods. The de novo model consisted of a decision tree and a state\u2013transition cohort model. A lifetime time horizon (of 60 years) was used.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Thirty-seven studies (123 publications) were included in the review. The high-sensitivity cardiac troponin test strategies evaluated are defined by the combination of four factors (i.e. assay, number and timing of tests, and threshold concentration), resulting in a large number of possible combinations. Clinical opinion indicated a minimum clinically acceptable sensitivity of 97%. When considering single test strategies, only those using a threshold at or near to the limit of detection for the assay, in a sample taken at presentation, met the minimum clinically acceptable sensitivity criterion. The majority of the multiple test strategies that met this criterion comprised an initial rule-out step, based on high-sensitivity cardiac troponin levels in a sample taken on presentation and a minimum symptom duration, and a second stage for patients not meeting the initial rule-out criteria, based on presentation levels of high-sensitivity cardiac troponin and absolute change after 1, 2 or 3 hours. Two large cluster randomised controlled trials found that implementation of an early rule-out pathway for myocardial infarction reduced length of stay and rate of hospital admission without increasing cardiac events. In the base-case analysis, standard troponin testing was both the most effective and the most costly. Other testing strategies with a sensitivity of 100% (subject to uncertainty) were almost equally effective, resulting in the same life-year and quality-adjusted life-year gain at up to four decimal places. Comparisons based on the next best alternative showed that for willingness-to-pay values below \u00a38455 per quality-adjusted life-year, the Access High Sensitivity Troponin I (Beckman Coulter, Brea, CA, USA) [(symptoms >\u20093 hours AND <\u20094\u2009ng\/l at 0 hours) OR (<\u20095\u2009ng\/l AND \u0394 <\u20095\u2009ng\/l at 0 to 2 hours)] would be cost-effective. For thresholds between \u00a38455 and \u00a320,190 per quality-adjusted life-year, the Elecsys\u00ae<\/jats:sup> Troponin-T high sensitive (Roche, Basel, Switzerland) (<\u200912\u2009ng\/l at 0 hours AND \u0394 <\u20093\u2009ng\/l at 0 to 1 hours) would be cost-effective. For a threshold >\u2009\u00a320,190 per quality-adjusted life-year, the Dimension Vista\u00ae<\/jats:sup> High-Sensitivity Troponin I (Siemens Healthcare, Erlangen, Germany) (<\u20095\u2009ng\/l at 0 hours AND \u0394 <\u20092\u2009ng\/l at 0 to 1 hours) would be cost-effective.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n High-sensitivity cardiac troponin testing may be cost-effective compared with standard troponin testing.<\/jats:p>\n <\/jats:sec>\n \n Study registration<\/jats:title>\n This study is registered as PROSPERO CRD42019154716.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment<\/jats:italic>; Vol. 25, No. 33. See the NIHR Journals Library website for further project information.<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/hta25330","type":"journal-article","created":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T15:09:07Z","timestamp":1622560147000},"page":"1-276","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":47,"title":["High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation"],"prefix":"10.3310","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6257-0653","authenticated-orcid":true,"given":"Marie","family":"Westwood","sequence":"first","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5785-9228","authenticated-orcid":true,"given":"Bram","family":"Ramaekers","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2175-7999","authenticated-orcid":true,"given":"Sabine","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1463-5413","authenticated-orcid":true,"given":"Gill","family":"Worthy","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4487-9216","authenticated-orcid":true,"given":"Debra","family":"Fayter","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7443-4798","authenticated-orcid":true,"given":"Nigel","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8383-7732","authenticated-orcid":true,"given":"Titas","family":"Buksnys","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4763-2078","authenticated-orcid":true,"given":"Janine","family":"Ross","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5649-6768","authenticated-orcid":true,"given":"Manuela","family":"Joore","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2787-7091","authenticated-orcid":true,"given":"Jos","family":"Kleijnen","sequence":"additional","affiliation":[{"name":"Kleijnen Systematic Reviews Ltd, York, UK"},{"name":"School for Public Health and Primary Care, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2021,5]]},"reference":[{"key":"key20210601144026408_ref1-bib1","unstructured":"Chalkidou A, Erskine J, Radhakrishnan Kartha M, Langford T, Macmillan T, Keevil S. 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