High-Sensitivity Troponin Dead End

Another article trying to work the unworkable - the balance between sensitivity and specificity.

From New Zealand, an attempt to evaluate the Roche Laboratories hsTnT assay in the interests of performing accelerated rule outs in the ED - looking at any combination of initial value, 2-hour value, delta between 0-2 hour value, etc.  And, essentially, any strategy you choose is wrong.

On one hand, you can get up to 91.4% specific for their gold  standard of AMI by requiring a hsTnT  >14 ng/L and a 20% delta change at 2 hours - but your sensitivity will drop to 72%.  Conversely, you can have sensitivity of 98.8% - which is the point of these hsTnT testing strategies - but your specificity drops to 56.4%.  Unless you're doing something intelligent with all those false positives that isn't harmful, expensive, or invasive, the costs of zero-miss are, once again, too high.

"High-sensitivity troponin T for early rule-out of myocardial infarction in recent onset chest pain"

http://www.ncbi.nlm.nih.gov/pubmed/22109535