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Int J Cardiol. 2015 Apr 1;184:208-15. doi: 10.1016/j.ijcard.2015.02.006. Epub 2015 Feb 11.

Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients.

Author information

1
Department of Cardiology, University Hospital, Basel, Switzerland.
2
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
3
Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
4
Christchurch Hospital, Christchurch, New Zealand.
5
Department of Cardiology, University Hospital, Basel, Switzerland; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
6
Department of Laboratory Medicine, University Hospital, Basel, Switzerland.
7
Department of Cardiology, University Hospital, Basel, Switzerland; Servicio de Urgencias y Pneumologia, CIBERES ISC III, Hospital del Mar, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
8
Emergency Department, San Martino University Hospital, Genoa, Italy.
9
Kantonsspital Olten, Switzerland.
10
Christchurch Heart Institute, University of Otago, Christchurch, New Zealand.
11
CCRE Therapeutics, Monash University, Australia.
12
Department of Cardiology, University Hospital, Basel, Switzerland. Electronic address: christian.mueller@usbs.ch.

Abstract

BACKGROUND:

We aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute myocardial infarction (AMI) for rapid rule-out of AMI.

METHODS:

In two independent large multicenter studies, levels of hs-cTnT at presentation and at 2 h were combined with the Thrombolysis In Myocardial Infarction (TIMI) risk score and ECG findings. The ADP defined patients with normal levels of hs-cTnT at presentation and 2 h, a TIMI score ≤1, and normal ECG findings as candidates for rapid rule-out of AMI and rapid discharge. Major adverse cardiac events (MACEs) occurring within 30-days were centrally adjudicated by two independent cardiologists.

RESULTS:

In the derivation cohort, among 1085 consecutive patients 198 patients (18.2%) had a MACE. The ADP classified 374 patients (34.5%) as low-risk. None of these patients had a MACE at 30 days, resulting in a negative predictive value (NPV) of 100% (95% CI, 99.0-100%) and a sensitivity of 100% (95% CI, 98.2%-100%). In the validation cohort, among 1590 consecutive patients 231 patients (14.5%) had a MACE. The ADP classified 641 patients (40.3%) as low-risk. 6 of these patients had a MACE at 30 days, resulting in a NPV of 99.1% (95% CI, 98.0-99.6%) and a sensitivity of 97.4% (95% CI, 94.5-98.8%).

CONCLUSIONS:

The ADP including hs-cTnT allows early identification 35 to 40% of patients to be at extremely low risk of MACE and therefore ideal candidates for outpatient management.

KEYWORDS:

Acute chest pain; Cardiac troponin; ECG; MACE; TIMI score

PMID:
25710784
DOI:
10.1016/j.ijcard.2015.02.006
[Indexed for MEDLINE]

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