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”