Rapid rule out of acute myocardial infarction using undetectable levels of high-sensitivity cardiac troponin

TY - JOUR

T1 - Rapid rule out of acute myocardial infarction using undetectable levels of high-sensitivity cardiac troponin

AU - Rubini Giménez, Maria

AU - Hoeller, Rebeca

AU - Reichlin, Tobias

AU - Zellweger, Christa

AU - Twerenbold, Raphael

AU - Reiter, Miriam

AU - Moehring, Berit

AU - Wildi, Karin

AU - Mosimann, Tamina

AU - Mueller, Mira

AU - Meller, Bernadette

AU - Hochgruber, Thomas

AU - Ziller, Ronny

AU - Sou, Seoung Mann

AU - Murray, Karsten

AU - Sakarikos, Konstantin

AU - Ernst, Susanne

AU - Gea, Joaquim

AU - Campodarve, Isabel

AU - Vilaplana, Carles

AU - Haaf, Philip

AU - Steuer, Stephan

AU - Minners, Jan

AU - Osswald, Stefan

AU - Mueller, Christian

N1 - Funding Information: This study was supported by research grants from the Swiss National Science Foundation ( PP00B-102853 ), the Swiss Heart Foundation , Abbott , Roche , Siemens , and the Department of Internal Medicine, University Hospital Basel . Funding Information: Prof. Mueller has received research grants from the Swiss National Science Foundation (PP00B-102853) and the Swiss Heart Foundation, the StiftungfürkardiovaskuläreForschung Basel, 8sense, Abbott, ALERE, Brahms, Critical Diagnostics, Nanosphere, Roche, Siemens, and the Department of Internal Medicine, of the University Hospital Basel, as well as speaker honoraria from Abbott, ALERE, Brahms, Novartis, Roche, and Siemens. We disclose that Dr. Reichlin has received research grants from the Swiss National Science Foundation (PASMP3-136995), the Swiss Heart Foundation, the University of Basel, the Professor Max Cloetta Foundation and the Department of Internal Medicine, University Hospital Basel as well as speakers honoraria from Brahms and Roche. All other authors declare that they have no conflict of interest with this study. The hs-cTn assays were donated by their respective manufacturers, who had no role in the design of the study, the analysis of the data, the preparation of the manuscript, or the decision to submit the manuscript for publication.

PY - 2013/10/9

Y1 - 2013/10/9

N2 - Background We examined whether undetectable levels of high-sensitivity cardiac Troponin (hs-cTn) can be used to rule out acute myocardial infarction (AMI) with a single blood draw at presentation to the emergency department (ED). Methods and results In a prospective multicenter study we used 4 different hs-cTn assays (hs-cTnT Roche, and hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting with acute chest pain. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available data including serial hs-cTnT levels. Mean follow up was 24 months. Among 2072 consecutive patients with available hs-cTnT levels, 21% had an adjudicated diagnosis of AMI. Among AMI patients, 98.2% had initially detectable levels of hs-cTnT (sensitivity 98.2%, 95%CI 96.3%-99.2%, negative predictive value (NPV) 98.6%, 95%CI 97.0%-99.3%). Undetectable levels of hs-cTnT ruled out AMI in 26.5% of patients at presentation. The NPV was similar with the three hs-cTnI assays: among 1180 consecutive patients with available hs-cTnI (Siemens), the NPV was 98.8%; among 1151 consecutive patients with available hs-cTnI (Beckman Coulter), the NPV was 99.2%; among 1567 consecutive patients with available hs-cTnI (Abbott), the NPV was 100.0%. The percentage of patients with undetectable levels of hs-cTnI was similar among the three hs-cTnI assays and ranged from 11.4% to 13.9%. Conclusions Undetectable levels of hs-cTn at presentation have a very high NPV and seem to allow the simple and rapid rule out of AMI. This criteria applies to much more patients with hs-TnT as compared to the investigated hs-cTnI assays.

AB - Background We examined whether undetectable levels of high-sensitivity cardiac Troponin (hs-cTn) can be used to rule out acute myocardial infarction (AMI) with a single blood draw at presentation to the emergency department (ED). Methods and results In a prospective multicenter study we used 4 different hs-cTn assays (hs-cTnT Roche, and hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting with acute chest pain. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available data including serial hs-cTnT levels. Mean follow up was 24 months. Among 2072 consecutive patients with available hs-cTnT levels, 21% had an adjudicated diagnosis of AMI. Among AMI patients, 98.2% had initially detectable levels of hs-cTnT (sensitivity 98.2%, 95%CI 96.3%-99.2%, negative predictive value (NPV) 98.6%, 95%CI 97.0%-99.3%). Undetectable levels of hs-cTnT ruled out AMI in 26.5% of patients at presentation. The NPV was similar with the three hs-cTnI assays: among 1180 consecutive patients with available hs-cTnI (Siemens), the NPV was 98.8%; among 1151 consecutive patients with available hs-cTnI (Beckman Coulter), the NPV was 99.2%; among 1567 consecutive patients with available hs-cTnI (Abbott), the NPV was 100.0%. The percentage of patients with undetectable levels of hs-cTnI was similar among the three hs-cTnI assays and ranged from 11.4% to 13.9%. Conclusions Undetectable levels of hs-cTn at presentation have a very high NPV and seem to allow the simple and rapid rule out of AMI. This criteria applies to much more patients with hs-TnT as compared to the investigated hs-cTnI assays.

KW - Acute myocardial infarction

KW - High sensitive cardiac troponin

KW - Rapid rule-out

UR - http://www.scopus.com/inward/record.url?scp=84886304639&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2013.06.049

DO - 10.1016/j.ijcard.2013.06.049

M3 - SCORING: Journal article

C2 - 23876467

AN - SCOPUS:84886304639

VL - 168

SP - 3896

EP - 3901

JO - INT J CARDIOL

JF - INT J CARDIOL

SN - 0167-5273

IS - 4

ER -