Format

Send to

Choose Destination
See comment in PubMed Commons below
Lancet. 2015 Dec 19;386(10012):2481-8. doi: 10.1016/S0140-6736(15)00391-8. Epub 2015 Oct 8.

High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study.

Author information

1
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. Electronic address: anoop.shah@ed.ac.uk.
2
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
3
Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
4
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
5
Department of Biochemistry, Queen Elizabeth University Hospital, Glasgow, UK.
6
Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
7
Division of Clinical Sciences, St George's, University of London, London, UK.
8
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
9
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.

Abstract

BACKGROUND:

Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits.

METHODS:

We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123).

FINDINGS:

782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3-99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8-99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21-0·80; p<0·0001).

INTERPRETATION:

Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital. Implementation of this approach could substantially reduce hospital admissions and have major benefits for both patients and health-care providers.

FUNDING:

British Heart Foundation and Chief Scientist Office (Scotland).

PMID:
26454362
PMCID:
PMC4765710
DOI:
10.1016/S0140-6736(15)00391-8
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center