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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, Vol. 184, No. 1, 2015, p. 208-215.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Meller, B, Cullen, L, Parsonage, WA, Greenslade, JH, Aldous, S, Reichlin, T, Wildi, K, Twerenbold, R, Jaeger, C, Hillinger, P, Haaf, P, Puelacher, C, Kern, V, Rentsch, K, Stallone, F, Gimenez, MR, Ballarino, P, Bassetti, S, Walukiewicz, A, Troughton, R, Pemberton, CJ, Richards, AM, Chu, K, Reid, CM, Than, M & Mueller, C 2015, 'Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients', INT J CARDIOL, vol. 184, no. 1, pp. 208-215. https://doi.org/10.1016/j.ijcard.2015.02.006

APA

Meller, B., Cullen, L., Parsonage, W. A., Greenslade, J. H., Aldous, S., Reichlin, T., Wildi, K., Twerenbold, R., Jaeger, C., Hillinger, P., Haaf, P., Puelacher, C., Kern, V., Rentsch, K., Stallone, F., Gimenez, M. R., Ballarino, P., Bassetti, S., Walukiewicz, A., ... Mueller, C. (2015). Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients. INT J CARDIOL, 184(1), 208-215. https://doi.org/10.1016/j.ijcard.2015.02.006

Vancouver

Meller B, Cullen L, Parsonage WA, Greenslade JH, Aldous S, Reichlin T et al. Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients. INT J CARDIOL. 2015;184(1):208-215. https://doi.org/10.1016/j.ijcard.2015.02.006

Bibtex

@article{3140ff508ae346d187bf5df6b801b65b,
title = "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.",
keywords = "Acute chest pain, Cardiac troponin, ECG, MACE, TIMI score",
author = "Bernadette Meller and Louise Cullen and Parsonage, {William A.} and Greenslade, {Jaimi H.} and Sally Aldous and Tobias Reichlin and Karin Wildi and Raphael Twerenbold and Cedric Jaeger and Petra Hillinger and Philip Haaf and Christian Puelacher and Vera Kern and Katharina Rentsch and Fabio Stallone and Gimenez, {Maria Rubini} and Paola Ballarino and Stefano Bassetti and Astrid Walukiewicz and Richard Troughton and Pemberton, {Christopher J.} and Richards, {A. Mark} and Kevin Chu and Reid, {Christopher M.} and Martin Than and Christian Mueller",
note = "Publisher Copyright: {\textcopyright} 2015 Elsevier Ireland Ltd. All rights reserved.",
year = "2015",
doi = "10.1016/j.ijcard.2015.02.006",
language = "English",
volume = "184",
pages = "208--215",
journal = "INT J CARDIOL",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

RIS

TY - JOUR

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 -