Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients
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Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients. / Meller, Bernadette; Cullen, Louise; Parsonage, William A.; Greenslade, Jaimi H.; Aldous, Sally; Reichlin, Tobias; Wildi, Karin; Twerenbold, Raphael; Jaeger, Cedric; Hillinger, Petra; Haaf, Philip; Puelacher, Christian; Kern, Vera; Rentsch, Katharina; Stallone, Fabio; Gimenez, Maria Rubini; Ballarino, Paola; Bassetti, Stefano; Walukiewicz, Astrid; Troughton, Richard; Pemberton, Christopher J.; Richards, A. Mark; Chu, Kevin; Reid, Christopher M.; Than, Martin; Mueller, Christian.
in: INT J CARDIOL, Jahrgang 184, Nr. 1, 2015, S. 208-215.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients
AU - Meller, Bernadette
AU - Cullen, Louise
AU - Parsonage, William A.
AU - Greenslade, Jaimi H.
AU - Aldous, Sally
AU - Reichlin, Tobias
AU - Wildi, Karin
AU - Twerenbold, Raphael
AU - Jaeger, Cedric
AU - Hillinger, Petra
AU - Haaf, Philip
AU - Puelacher, Christian
AU - Kern, Vera
AU - Rentsch, Katharina
AU - Stallone, Fabio
AU - Gimenez, Maria Rubini
AU - Ballarino, Paola
AU - Bassetti, Stefano
AU - Walukiewicz, Astrid
AU - Troughton, Richard
AU - Pemberton, Christopher J.
AU - Richards, A. Mark
AU - Chu, Kevin
AU - Reid, Christopher M.
AU - Than, Martin
AU - Mueller, Christian
N1 - Publisher Copyright: © 2015 Elsevier Ireland Ltd. All rights reserved.
PY - 2015
Y1 - 2015
N2 - 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.
AB - 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.
KW - Acute chest pain
KW - Cardiac troponin
KW - ECG
KW - MACE
KW - TIMI score
UR - http://www.scopus.com/inward/record.url?scp=84933529143&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2015.02.006
DO - 10.1016/j.ijcard.2015.02.006
M3 - SCORING: Journal article
C2 - 25710784
AN - SCOPUS:84933529143
VL - 184
SP - 208
EP - 215
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
IS - 1
ER -