RESUMEN
BACKGROUND: Point-of-care (POC) high-sensitivity cardiac troponin assays may further accelerate the diagnosis of myocardial infarction (MI). OBJECTIVES: This study sought to assess the clinical and analytical performance of the novel high-sensitivity cardiac troponin I (hs-cTnI)-SPINCHIP POC test. METHODS: Adult patients presenting with acute chest discomfort to the emergency department were enrolled in an international, diagnostic, multicenter study. The final diagnosis was centrally adjudicated by 2 independent cardiologists using all clinical information. We compared the discriminatory performance of hs-cTnI-SPINCHIP with current established central laboratory assays and derived an assay-specific hs-cTnI-SPINCHIP 0/1-hour algorithm. Secondary analyses included sample type comparisons (whole blood, fresh/frozen plasma, and capillary finger prick) and precision analysis. RESULTS: MI was the adjudicated final diagnosis in 214 (19%) of 1,102 patients. Area under the receiver-operating characteristic curve was 0.94 (95% CI: 0.92-0.95) for hs-cTnI-SPINCHIP vs 0.94 (95% CI: 0.92-0.95) for hs-cTnI-Architect (P = 0.907) and 0.93 (95% CI: 0.91-0.95) for high-sensitivity cardiac troponin T Elecsys (P = 0.305). A cutoff <7 ng/L at presentation (if chest pain onset was >3 hours) or <7 ng/L together with a 0/1-hour delta of <4 ng/L ruled out 51% with a sensitivity and negative predictive value of 100% (95% CI: 97.7%-100%) and 100% (95% CI: 99.0%-100%), respectively. A hs-cTnI-SPINCHIP concentration ≥36 ng/L or a 0/1-hour delta ≥11 ng/L ruled in 27% with a specificity and positive predictive value of 90.9% (95% CI: 88.3%-92.9%) and 72.9% (95% CI: 66.4%-78.6%), respectively. Bootstrap internal validation confirmed excellent diagnostic performance. High agreement was observed between different sample types. CONCLUSIONS: The SPINCHIP hs-cTnI POC test has very high diagnostic accuracy. Its assay-specific 0/1-hour algorithm achieved very high sensitivity/negative predictive value and specificity/positive predictive value for rule-out/in MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study [APACE]; NCT00470587).
Asunto(s)
Infarto del Miocardio , Troponina I , Humanos , Troponina I/sangre , Masculino , Femenino , Persona de Mediana Edad , Anciano , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico , Sistemas de Atención de Punto , Biomarcadores/sangre , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
The outbreak of the COVID-19 pandemic posed an immediate challenge to the management of hospitals in Germany and elsewhere. The risk of stress for front-line healthcare professionals forced occupational health and safety units to adopt a variety of protective measures, not all of which have been thoroughly validated. The main objective of the present analysis is to assess what the most important sources of stress were and which of the protective measures applied to counteract stress among healthcare staff had the greatest impact. A better understanding of these factors will improve hospital management and worker safety in a future health crisis situation and may also prove to be beneficial in non-crisis situations. For this purpose, in 2020, an exploratory, cross-sectional and quantitative study using a questionnaire created for this purpose was carried out on a total of 198 professionals-133 nurses and 65 physicians-at the Klinikum Mittelbaden Balg hospital in Baden-Baden, Germany, during the first wave of the pandemic. Statistical analyses showed that nurses suffer more stress than physicians and that stress is higher among professionals in critical care and emergency units than in units that are less exposed to infected patients. It was also found that measures such as salary incentives, encouragement of work in well-integrated teams, and perceived support from hospital management mitigate stress. These findings highlight the importance of support measures from management and superiors. Knowing the actual effectiveness of the measures applied by management and the factors mentioned above could help to protect healthcare professionals in the event of another pandemic or similar situations and may still be of value in dealing with the continuing COVID-19 pandemic.