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Clin Chem. 2017 Jan;63(1):394-402. doi: 10.1373/clinchem.2016.262659. Epub 2016 Nov 30.

Immediate Rule-Out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-Sensitivity Troponin I.

Author information

1
Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany; j.neumann@uke.de.
2
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
3
Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
4
Department of Cardiology, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany.
5
Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany and Clinical Chemistry, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
6
Department of Cardiology, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
7
Department of Medicine, Nykoebing F Hospital, University of Southern Denmark, Odense, Denmark.
8
Emergency Department, Christchurch Hospital, Christchurch, New Zealand.
9
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.

Abstract

AIMS:

Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI.

METHODS:

Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months.

RESULTS:

184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low risk ECG resulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT).

CONCLUSIONS:

A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing.

TRIAL REGISTRATION:

www.clinicaltrials.gov (NCT02355457).

PMID:
27903616
DOI:
10.1373/clinchem.2016.262659
[Indexed for MEDLINE]
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