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Assessment of diagnostic and prognostic accuracyRepresentative spectrum?Acceptable reference standard?Acceptable delay between tests?Partial verification avoided?Differential verification avoided?Incorporation avoided?Reference standard results blinded?Index test results blinded?Yes (high quality)UnclearNo (low quality)0% 25% 50% 75% 100%FIGURE 6 Methodological quality summary of diagnostic studies of TnT.TABLE 7 Reported results of all studies of TnIStudyBiomarkerThresholdvalueThresholddefinitionReportedsensitivityReportedspecificityAmodio 2007 52 Dade Behring Stratus CS 0.03 99th percentile 0.773 0.84Amodio 2007 52 Dade Behring Stratus CS 0.07 10% CV 0.636 0.931Apple 2008 53 BioMérieux VIDAS TnI-Ultra 0.01 99th percentile 0.882 0.799Apple 2008 53 BioMérieux VIDAS TnI-Ultra 0.11 10% CV 0.763 0.944Apple 2008 54 ADVIA Centaur Ultra 0.006 LoD 0.96 0.33Apple 2008 54 ADVIA Centaur Ultra 0.04 99th percentile 0.74 0.84Apple 2009 55Dade Behring Stratus CS andDimension RxL0.1 99th percentile 0.72 0.89Bassan 2005 56 Dade Behring 1 Not stated 0.507 0.988Body 2011 57 Alere 0.055 99th percentile 0.42 0.96Charpentier 2010 59 ADVIA Centaur Ultra 0.1 99th percentile 0.561 0.986Collinson 2006 62 EuroDPC Immulite 0.2 10% CV 0.9 NRCollinson 2006 48 Beckman Coulter AccuTnI assay 0.03 10% CV 0.946 NRDi Serio 2005 63 Randox Evidence Investigator 1 Not stated 0.687 0.93Ecollan 2007 64 Biosite Triage 0.4 Not stated 0.218 1Garcia-Valdecasas2011 49 ELISA (DainipponPharmaceutical, Japan)0.6 Not stated 0.25 0.91Guo 2006 66 Roche Cardiac Reader 0.1 Not stated 0.952 0.938Ilva 2009 50 Abbot Architect 0.032 99th percentile 0.784 1Keating 2006 70 Beckman Access 0.06 Not stated 0.74 0.99Keller 2009 20 ADVIA Centaur Ultra 0.04 99th percentile 0.907 0.902LeFevre 2007 72Dade Behring RxL or SiemensCentaur0.14 or0.3310% CV 0.66 0.95Liao 2009 74 Not stated 0.5 Not stated 0.648 0.530NIHR Journals Library
DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 1TABLE 7 Reported results of all studies of TnI (continued)StudyBiomarkerThresholdvalueThresholddefinitionReportedsensitivityReportedspecificityMion 2007 77 Evidence Cardiac Panel 0.47 Not stated 0.548 0.978Reichlin 2009 19 ADVIA Centaur Ultra 0.04 99th percentile 0.89 0.92Reichlin 2009 19 ADVIA Centaur Ultra 0.006 LoD 0.97 0.68Reichlin 2009 19 Abbot Architect 0.028 99th percentile 0.88 0.92Reichlin 2009 19 Abbot Architect 0.032 10% CV 0.85 0.93Reichlin 2009 19 Abbot Architect 0.01 LoD 0.94 0.87Reichlin 2009 19 Roche 0.16 99th percentile 0.84 0.94Reichlin 2009 19 Roche 0.3 10% CV 0.75 0.97Reichlin 2009 19 Roche 0.1 LoD 0.92 0.88Rudolph 2010 81 Abbot Architect 0.032 10% CV 0.859 0.897TABLE 8 Reported results of all studies of TnTStudyBiomarkerThresholdvalueThresholddefinitionReportedsensitivityReportedspecificityBody 2011 46 Fourth-generation TnT 0.01 99th percentile 0.748 0.937Cete 2010 58 Not stated 0.1 Not stated 0.452 1Christ 2010 60 Fourth-generation TnT 0.01 99th percentile 0.9 0.812Christ 2010 60 Fourth-generation TnT 0.04 10% CV 0.65 0.906Christ 2010 60 HsTnT 0.003 LoD 1 0.214Christ 2010 60 HsTnT 0.014 99th percentile 0.95 0.615Collinson 2006 62 Third-generation TnT 0.03 10% CV NR NRHaltern 2010 67 Roche TnT 0.03 10% CV 0.74 1Keller 2009 20 Fourth-generation TnT 0.03 10% CV 0.637 0.972Keller 2009 20 Fourth-generation TnT 0.01 99th percentile 0.727 0.921Li 2010 73 Not stated 0.1 Not stated 0.693 0.9754McCann 2008 76 Roche TnT 0.03 10% CV 0.75 0.94Naroo 2009 78 Not stated 0.03 Not stated 0.586 0.989Reichlin 2009 19 HsTnT 0.014 99th percentile 0.95 0.8Reichlin 2009 19 HsTnT 0.002 LoD 1 0.14Reichlin 2009 19 Fourth-generation TnT 0.035 10% CV 0.72 0.97Reichlin 2009 19 Fourth-generation TnT 0.01 99th percentile 0.83 0.93Valle 2008 82 Not stated Unclear Not stated 0.19 0.99© Queen’s Printer and Controller of HMSO 2013. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of Statefor Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journalsprovided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton SciencePark, Southampton SO16 7NS, UK.31
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Page 22 and 23: BackgroundTABLE 1 Hospital admissio
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Discussionspecificity were 62% (95%
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Discussionneed for revascularisatio
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Discussionchanges in sensitivity an
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Discussionuncertainty about these p
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Discussiontroponin assays have bett
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ConclusionsSuggested research prior
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Appendix 9ES (Information Resources
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Appendix 923. Westwood ME, Whiting
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