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How safe is the outpatient management of patients with acute chest pain and mildly increased cardiac troponin concentrations?

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How safe is the outpatient management of patients with acute chest pain and mildly increased cardiac troponin concentrations? / Meune, Christophe; Reichlin, Tobias; Irfan, Affan; Schaub, Nora; Twerenbold, Raphael; Meissner, Julia; Reiter, Miriam; Lüthi, Adrian; Haaf, Philip; Balmelli, Cathrin; Drexler, Beatrice; Winkler, Katrin; Hochholzer, Willibald; Osswald, Stefan; Mueller, Christian.

in: CLIN CHEM, Jahrgang 58, Nr. 5, 05.2012, S. 916-924.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Meune, C, Reichlin, T, Irfan, A, Schaub, N, Twerenbold, R, Meissner, J, Reiter, M, Lüthi, A, Haaf, P, Balmelli, C, Drexler, B, Winkler, K, Hochholzer, W, Osswald, S & Mueller, C 2012, 'How safe is the outpatient management of patients with acute chest pain and mildly increased cardiac troponin concentrations?', CLIN CHEM, Jg. 58, Nr. 5, S. 916-924. https://doi.org/10.1373/clinchem.2011.178053

APA

Meune, C., Reichlin, T., Irfan, A., Schaub, N., Twerenbold, R., Meissner, J., Reiter, M., Lüthi, A., Haaf, P., Balmelli, C., Drexler, B., Winkler, K., Hochholzer, W., Osswald, S., & Mueller, C. (2012). How safe is the outpatient management of patients with acute chest pain and mildly increased cardiac troponin concentrations? CLIN CHEM, 58(5), 916-924. https://doi.org/10.1373/clinchem.2011.178053

Vancouver

Meune C, Reichlin T, Irfan A, Schaub N, Twerenbold R, Meissner J et al. How safe is the outpatient management of patients with acute chest pain and mildly increased cardiac troponin concentrations? CLIN CHEM. 2012 Mai;58(5):916-924. https://doi.org/10.1373/clinchem.2011.178053

Bibtex

@article{b6b3e3232a3e4eaab9344d6824b83f46,
title = "How safe is the outpatient management of patients with acute chest pain and mildly increased cardiac troponin concentrations?",
abstract = "BACKGROUND: The appropriate management of patients discharged from the emergency department (ED) with increased high-sensitivity cardiac troponin T (hs-cTnT) but normal or borderline-high conventional cardiac troponin concentrations is unknown. METHODS: Weinvestigated 643 consecutive ED patients with acute chest pain who had been discharged for outpatient management after acute myocardial infarction (AMI) had been ruled out by serial measurements of conventional cardiac troponin. hs-cTnT was measured blindly, and we calculated the rates of all-cause mortality (primary endpoint) and subsequent AMI (secondary endpoint) at 30, 90, and 360 days. RESULTS: hs-cTnT concentrations were increased (>14 ng/L) in 114 patients (18%) but <30 ng/L in 95% of these patients. Of those 114 patients, 96 (84%) had an adjudicated noncoronary cause of chest pain. Thirtyday mortality (95% CI) was 0.9% (0.1%-6.1%), 90-day mortality was 2.7% (0.9%-8.1%), and 360-day mortality was 5.2% (2.2%-11.9%) in patients with increased hs-cTnT; respective rates (95% CI) of AMI were 0.0%, 1.9% (0.5%-7.2%), and 7.6% (3.7%- 15.3%). Increased hs-cTnT was associated with increased mortality and AMI at 90 days (P < 0.006 and P < 0.081, respectively) and 360 days (P < 0.001 for both). CONCLUSIONS: hs-cTnT is a strong prognosticator of intermediate and long-Term mortality and AMI in lowrisk patients discharged from the ED after AMI has been ruled out. The relatively low rate of 30-day events may suggest that patients without acute coronary syndrome and small increases in cardiac troponin are in need of further investigations and treatments, but not necessarily immediate hospitalization.",
author = "Christophe Meune and Tobias Reichlin and Affan Irfan and Nora Schaub and Raphael Twerenbold and Julia Meissner and Miriam Reiter and Adrian L{\"u}thi and Philip Haaf and Cathrin Balmelli and Beatrice Drexler and Katrin Winkler and Willibald Hochholzer and Stefan Osswald and Christian Mueller",
year = "2012",
month = may,
doi = "10.1373/clinchem.2011.178053",
language = "English",
volume = "58",
pages = "916--924",
journal = "CLIN CHEM",
issn = "0009-9147",
publisher = "American Association for Clinical Chemistry Inc.",
number = "5",

}

RIS

TY - JOUR

T1 - How safe is the outpatient management of patients with acute chest pain and mildly increased cardiac troponin concentrations?

AU - Meune, Christophe

AU - Reichlin, Tobias

AU - Irfan, Affan

AU - Schaub, Nora

AU - Twerenbold, Raphael

AU - Meissner, Julia

AU - Reiter, Miriam

AU - Lüthi, Adrian

AU - Haaf, Philip

AU - Balmelli, Cathrin

AU - Drexler, Beatrice

AU - Winkler, Katrin

AU - Hochholzer, Willibald

AU - Osswald, Stefan

AU - Mueller, Christian

PY - 2012/5

Y1 - 2012/5

N2 - BACKGROUND: The appropriate management of patients discharged from the emergency department (ED) with increased high-sensitivity cardiac troponin T (hs-cTnT) but normal or borderline-high conventional cardiac troponin concentrations is unknown. METHODS: Weinvestigated 643 consecutive ED patients with acute chest pain who had been discharged for outpatient management after acute myocardial infarction (AMI) had been ruled out by serial measurements of conventional cardiac troponin. hs-cTnT was measured blindly, and we calculated the rates of all-cause mortality (primary endpoint) and subsequent AMI (secondary endpoint) at 30, 90, and 360 days. RESULTS: hs-cTnT concentrations were increased (>14 ng/L) in 114 patients (18%) but <30 ng/L in 95% of these patients. Of those 114 patients, 96 (84%) had an adjudicated noncoronary cause of chest pain. Thirtyday mortality (95% CI) was 0.9% (0.1%-6.1%), 90-day mortality was 2.7% (0.9%-8.1%), and 360-day mortality was 5.2% (2.2%-11.9%) in patients with increased hs-cTnT; respective rates (95% CI) of AMI were 0.0%, 1.9% (0.5%-7.2%), and 7.6% (3.7%- 15.3%). Increased hs-cTnT was associated with increased mortality and AMI at 90 days (P < 0.006 and P < 0.081, respectively) and 360 days (P < 0.001 for both). CONCLUSIONS: hs-cTnT is a strong prognosticator of intermediate and long-Term mortality and AMI in lowrisk patients discharged from the ED after AMI has been ruled out. The relatively low rate of 30-day events may suggest that patients without acute coronary syndrome and small increases in cardiac troponin are in need of further investigations and treatments, but not necessarily immediate hospitalization.

AB - BACKGROUND: The appropriate management of patients discharged from the emergency department (ED) with increased high-sensitivity cardiac troponin T (hs-cTnT) but normal or borderline-high conventional cardiac troponin concentrations is unknown. METHODS: Weinvestigated 643 consecutive ED patients with acute chest pain who had been discharged for outpatient management after acute myocardial infarction (AMI) had been ruled out by serial measurements of conventional cardiac troponin. hs-cTnT was measured blindly, and we calculated the rates of all-cause mortality (primary endpoint) and subsequent AMI (secondary endpoint) at 30, 90, and 360 days. RESULTS: hs-cTnT concentrations were increased (>14 ng/L) in 114 patients (18%) but <30 ng/L in 95% of these patients. Of those 114 patients, 96 (84%) had an adjudicated noncoronary cause of chest pain. Thirtyday mortality (95% CI) was 0.9% (0.1%-6.1%), 90-day mortality was 2.7% (0.9%-8.1%), and 360-day mortality was 5.2% (2.2%-11.9%) in patients with increased hs-cTnT; respective rates (95% CI) of AMI were 0.0%, 1.9% (0.5%-7.2%), and 7.6% (3.7%- 15.3%). Increased hs-cTnT was associated with increased mortality and AMI at 90 days (P < 0.006 and P < 0.081, respectively) and 360 days (P < 0.001 for both). CONCLUSIONS: hs-cTnT is a strong prognosticator of intermediate and long-Term mortality and AMI in lowrisk patients discharged from the ED after AMI has been ruled out. The relatively low rate of 30-day events may suggest that patients without acute coronary syndrome and small increases in cardiac troponin are in need of further investigations and treatments, but not necessarily immediate hospitalization.

UR - http://www.scopus.com/inward/record.url?scp=84860663173&partnerID=8YFLogxK

U2 - 10.1373/clinchem.2011.178053

DO - 10.1373/clinchem.2011.178053

M3 - SCORING: Journal article

C2 - 22410086

AN - SCOPUS:84860663173

VL - 58

SP - 916

EP - 924

JO - CLIN CHEM

JF - CLIN CHEM

SN - 0009-9147

IS - 5

ER -