Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients
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 Throm bolysis 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.
Bibliografische Daten
| Originalsprache | Englisch |
|---|---|
| ISSN | 0167-5273 |
| DOIs | |
| Status | Veröffentlicht - 2015 |
| Extern publiziert | Ja |
Anmerkungen des Dekanats
Funding Information:
We disclose that Dr. Reichlin has received research grants from the Swiss National Science Foundation (PASMP3-136995), the Swiss Heart Foundation, the Professor Max Cloëtta Foundation, the University of Basel and the Department of Internal Medicine, University Hospital Basel as well as speaker honoraria from Brahms and Roche. Dr. Mueller has received research support from the European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, Abbott, Alere, BRAHMS, Nanosphere, Roche, Siemens, and the Department of Internal Medicine, University Hospital Basel, as well as speaker/consulting honoraria from Abbott, Alere, Astra-Zeneca, BG-medicine, bioMérieux Clinical Diagnostics, BRAHMS, Cardiorentis, Daiichi, Lilly, Novartis, Radiometer, Roche, and Siemens. A/Prof Cullen received funding from the Queensland Emergency Medical Research Foundation for chest pain clinical trials, from Abbott Diagnostics, Roche, Alere, Siemens and Radiometer Pacific for clinical trials, from Alere, Boehringer Ingelhiem, Pfizer, AstraZenica, Abbott Diagnostics and Radiometer Pacific for speaking and education. Dr Parsonage received research support from Roche, Alere, Abbott Diagnostics and Siemens. He has received honoraria from Abbott. A/Prof Greenslade has been a co-investigator on grants from the Queensland Emergency Medicine Research Foundation, Roche and Siemens. SA received funding from the National Heart Foundation (NZ) for cardiac research. CJP receives funding from the Health Research Council of New Zealand for studies investigating novel diagnostic markers of acute coronary syndromes. AMR receives speaker honoraria and from Roche Dx and Alere for research support. KC has funding from the Queensland Emergency Medicine Research Foundation for unrelated research. CMR receives funding from the National Health & Medical Research Council (Australia) for Cardiovascular Research. MT has funding from the Health Research Council (NZ) for two chest pain random clinical trials, from the New Zealand National Heart Foundation for analysis of blood troponins from a chest pain clinical trial, from Canterbury Community Trust for a diagnostic for unrelated research, and is Chair of the Emergency Care Foundation.
Funding Information:
All authors have read and approved the manuscript. The study was supported by research grants from the Swiss National Science Foundation , the Swiss Heart Foundation , Abbott , BRAHMS , Roche , Siemens , 8sense , Nanosphere , and the Department of Internal Medicine, University Hospital Basel .
Publisher Copyright:
© 2015 Elsevier Ireland Ltd. All rights reserved.
