Systematic review, meta-analysis and economic modelling of ...
Systematic review, meta-analysis and economic modelling of ... Systematic review, meta-analysis and economic modelling of ...
Assessment of diagnostic and prognostic accuracyTABLE 13 Population characteristics of studies of myoglobinStudy Study typePopulation:age (years); sex Inclusion criteria Exclusion criteriaTime fromsymptoms (hours)No. ofpatientsAmodio 2007 52 Single centre, Italy Mean age 61; 308 (60%) male Suspected clinical angina orAMISTEMI, new-onset LBBB 5.0 (median) 516Body 2011 57 Single centre, UK Mean age 59; 434 (61%) male Suspected cardiac chest painoccurring within the previous24 hoursChest trauma, renal failure, needinghospital admission, pregnancy3.5 (median) 713Cete 2010 58 Single centre, Turkey Mean age 57; 163 (73%) male Aged > 18 years presentingto the ED with typical chestpainAtypical pain, trauma, recentelectrical cardioversion,musculoskeletal disease, renal failure,liver diseaseNR 224Di Serio 2005 63 Single centre, Italy Mean age 79 (women), 65 (men);23 (77%) maleNot specified ST elevation 3.4 (mean) 30Ecollan 2007 64 Mobile units, France Mean age 68; 68 (63%) male Consecutive emergencieswith chest painCardiogenic shock, recent chesttrauma2.3 (median) 108Eggers 2004 18 Single centre, Sweden Median age 66; 130 (66%) male Chest pain within 24 hours,suspicious of unstable anginaor AMISTEMI 5.5 (median) 180Garcia-Valdecasas Single centre, France Mean age 67; 114 (69%) male Chest pain > 20 minutes’2011 49 duration within 6 hoursChest trauma NR 165Hjortshoj 2010 68 Single centre, UK Median range across three groups(60–63); 70 (65%) maleChest pain and suspectedof ACSNone reported NR 107Ilva 2005 69 Single centre, Finland Mean age 67; 314 (59%) male Suspected MI None reported 7.8 hours (median) 531Keller 2010 71 Multicentre, Germany Mean age 61; 920 (66%) male Aged 18–85 years withangina pectoris or equivalentsymptomsTrauma or major surgery within thelast 4 weeks, pregnancy, intravenousdrug abuse, anaemia57.6% < 6 hours 1386Liao 2009 74 Single centre, China Mean age 69; 54 (73%) male Onset of acute chest painand/or dyspnoea within thelast 3 hoursNone reported 2.2 (median) 74Mion 2007 77 Single centre, Italy Mean age 63; 88 (67%) male Non-consecutive patientswith chest painNone reported 3.8 (median) 132Penttilä 2002 79 Single centre, Finland Mean age 68; 246 (56%) male Chest pain within 12 hours None reported < 12 hours 440AMI, acute myocardial infarction; LBBB, left bundle branch block; NR, not reported.46NIHR Journals Library
DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 1TABLE 14 Index and reference standard tests used in studies of myoglobinStudyIndex testanalyser and timing Threshold (µg/l) Reference test assay and timingReference Tn diagnosticthreshold (µg/l)MI prevalence insample (%)Amodio 2007 52 Dade Behring Stratus CS 68 and 86 TNT; assay and timing not specified 0.07 21Body 2011 57 Alere Fluorescenceimmunoassay107 Roche Diagnostics, Elecsys at 12 hours from symptoms 0.01 18Cete 2010 58 Not stated 52 (women), 81 (men) TnT; assay not reported; 6 hours 0.1 33Di Serio 2005 63 Evidence Investigator 73.4 ESC/ACC, not further specified Not specified 53Ecollan 2007 64 Biosite Triage ® 150 Dade Behring TnI test at any time point over 24 hours 0.07 51Eggers 2004 18 Dade Behring Stratus CS 98 (men), 56 (women) Abbott AxSYM TnI; within 24 hours 0.1 22Garcia- Dade Dimension 92 (men), 76 (women) Dimension Analyser TnI, timing not stated 0.6 392011 49ValdecasasHjortshoj Roche Elecsys 51 (women), 72 (men) Roche Elecsys TnT after 6 to 9 hour and 12–24 hours 0.03 332010 68Ilva 2005 69 Innotrac Aio 150 Bayer Diagnostics TnI up to 24 hours 0.3 37Keller 2010 71 Not stated 107 Roche TnT or Siemens Dimension RxL TnI within 6 hours ofadmission0.3 (TnT)0.14 (TnI)29Liao 2009 74 Not stated 70 NR 1 73Mion 2007 77 Evidence ® Cardiac Panel 87 DimensionRxL TnI, timing not specified0.15 32Penttilä 2002 79 Hitachi 717 65 (men), 55 (women) Abbott IMx TnT at two different time points during72 hours0.1 30ACC, American College of Cardiology; ESC, European Society of Cardiology; NR, not reported.© 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.47
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Assessment <strong>of</strong> diagnostic <strong>and</strong> prognostic accuracyTABLE 13 Population characteristics <strong>of</strong> studies <strong>of</strong> myoglobinStudy Study typePopulation:age (years); sex Inclusion criteria Exclusion criteriaTime fromsymptoms (hours)No. <strong>of</strong>patientsAmodio 2007 52 Single centre, Italy Mean age 61; 308 (60%) male Suspected clinical angina orAMISTEMI, new-onset LBBB 5.0 (median) 516Body 2011 57 Single centre, UK Mean age 59; 434 (61%) male Suspected cardiac chest painoccurring within the previous24 hoursChest trauma, renal failure, needinghospital admission, pregnancy3.5 (median) 713Cete 2010 58 Single centre, Turkey Mean age 57; 163 (73%) male Aged > 18 years presentingto the ED with typical chestpainAtypical pain, trauma, recentelectrical cardioversion,musculoskeletal disease, renal failure,liver diseaseNR 224Di Serio 2005 63 Single centre, Italy Mean age 79 (women), 65 (men);23 (77%) maleNot specified ST elevation 3.4 (mean) 30Ecollan 2007 64 Mobile units, France Mean age 68; 68 (63%) male Consecutive emergencieswith chest painCardiogenic shock, recent chesttrauma2.3 (median) 108Eggers 2004 18 Single centre, Sweden Median age 66; 130 (66%) male Chest pain within 24 hours,suspicious <strong>of</strong> unstable anginaor AMISTEMI 5.5 (median) 180Garcia-Valdecasas Single centre, France Mean age 67; 114 (69%) male Chest pain > 20 minutes’2011 49 duration within 6 hoursChest trauma NR 165Hjortshoj 2010 68 Single centre, UK Median range across three groups(60–63); 70 (65%) maleChest pain <strong>and</strong> suspected<strong>of</strong> ACSNone reported NR 107Ilva 2005 69 Single centre, Finl<strong>and</strong> Mean age 67; 314 (59%) male Suspected MI None reported 7.8 hours (median) 531Keller 2010 71 Multicentre, Germany Mean age 61; 920 (66%) male Aged 18–85 years withangina pectoris or equivalentsymptomsTrauma or major surgery within thelast 4 weeks, pregnancy, intravenousdrug abuse, anaemia57.6% < 6 hours 1386Liao 2009 74 Single centre, China Mean age 69; 54 (73%) male Onset <strong>of</strong> acute chest pain<strong>and</strong>/or dyspnoea within thelast 3 hoursNone reported 2.2 (median) 74Mion 2007 77 Single centre, Italy Mean age 63; 88 (67%) male Non-consecutive patientswith chest painNone reported 3.8 (median) 132Penttilä 2002 79 Single centre, Finl<strong>and</strong> Mean age 68; 246 (56%) male Chest pain within 12 hours None reported < 12 hours 440AMI, acute myocardial infarction; LBBB, left bundle branch block; NR, not reported.46NIHR Journals Library
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