A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction
Background. Ruling out acute myocardial infarction (AMI) in the emergency department (ED) is challenging. Studies have shown that a high-sensitivity cardiac troponin T (hs-cTnT) <5 ng/L or <6 ng/L at presentation (0 h) can be used to rule out AMI. The objective of this study was to identify wh...
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| Format: | Article |
| Language: | English |
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Wiley
2024-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2024/2241528 |
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| author | Patrik Gilje Moman A. Mohammad Andreas Roos Ulf Ekelund Jonas Björk Bertil Lindahl Martin Holzmann Arash Mokhtari |
| author_facet | Patrik Gilje Moman A. Mohammad Andreas Roos Ulf Ekelund Jonas Björk Bertil Lindahl Martin Holzmann Arash Mokhtari |
| author_sort | Patrik Gilje |
| collection | DOAJ |
| description | Background. Ruling out acute myocardial infarction (AMI) in the emergency department (ED) is challenging. Studies have shown that a high-sensitivity cardiac troponin T (hs-cTnT) <5 ng/L or <6 ng/L at presentation (0 h) can be used to rule out AMI. The objective of this study was to identify whether an even higher hs-cTnT threshold can be used for a safe rule out of AMI in the ED. Methods. The derivation cohort consisted of 24,973 ED patients with a primary complaint of chest pain. In this cohort, we identified the highest concentration of 0 h hs-cTnT that corresponded to a negative predictive value (NPV) of ≥99.5% for the primary endpoint of AMI/all-cause death within 30 days and the secondary endpoint of all-cause death within one year. The results were validated in two cohorts consisting of 132,021 and 1167 ED chest pain patients. Results. The 0 h hs-cTnT threshold corresponding to a NPV of ≥99.5% for the primary endpoint was <9 ng/L (NPV: 99.6% and 95% CI: 99.5–99.7). This cutoff provided a sensitivity of 96.2% (95% CI: 95.2–97.1) and identified 59.7% of the patients as low risk compared to 35.8% and 43.9% with a 0 h hs-cTnT <5 ng/L and <6 ng/L, respectively. The results were similar in the validation cohorts and seemed to perform even better in patients where the 0 h hs-cTnT was measured >3 h after symptom onset and in those with a nonischemic ECG and nonhigh risk history. Conclusions. A 0 h hs-cTnT cutoff of <9 ng/L safely rules out AMI/death within 30 days in a majority of chest pain patients and is a more effective strategy than the currently recommended <5 ng/L and <6 ng/L cutoffs. This trial is registered with NCT03421873. |
| format | Article |
| id | doaj-art-78311831870c434eb6c081da0952dd53 |
| institution | Kabale University |
| issn | 2090-2859 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-78311831870c434eb6c081da0952dd532025-02-03T01:29:50ZengWileyEmergency Medicine International2090-28592024-01-01202410.1155/2024/2241528A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial InfarctionPatrik Gilje0Moman A. Mohammad1Andreas Roos2Ulf Ekelund3Jonas Björk4Bertil Lindahl5Martin Holzmann6Arash Mokhtari7Lund UniversityLund UniversityDepartment of MedicineLund UniversityOccupational and Environmental MedicineDepartment of Medical Sciences and Uppsala Clinical Research CenterDepartment of MedicineLund UniversityBackground. Ruling out acute myocardial infarction (AMI) in the emergency department (ED) is challenging. Studies have shown that a high-sensitivity cardiac troponin T (hs-cTnT) <5 ng/L or <6 ng/L at presentation (0 h) can be used to rule out AMI. The objective of this study was to identify whether an even higher hs-cTnT threshold can be used for a safe rule out of AMI in the ED. Methods. The derivation cohort consisted of 24,973 ED patients with a primary complaint of chest pain. In this cohort, we identified the highest concentration of 0 h hs-cTnT that corresponded to a negative predictive value (NPV) of ≥99.5% for the primary endpoint of AMI/all-cause death within 30 days and the secondary endpoint of all-cause death within one year. The results were validated in two cohorts consisting of 132,021 and 1167 ED chest pain patients. Results. The 0 h hs-cTnT threshold corresponding to a NPV of ≥99.5% for the primary endpoint was <9 ng/L (NPV: 99.6% and 95% CI: 99.5–99.7). This cutoff provided a sensitivity of 96.2% (95% CI: 95.2–97.1) and identified 59.7% of the patients as low risk compared to 35.8% and 43.9% with a 0 h hs-cTnT <5 ng/L and <6 ng/L, respectively. The results were similar in the validation cohorts and seemed to perform even better in patients where the 0 h hs-cTnT was measured >3 h after symptom onset and in those with a nonischemic ECG and nonhigh risk history. Conclusions. A 0 h hs-cTnT cutoff of <9 ng/L safely rules out AMI/death within 30 days in a majority of chest pain patients and is a more effective strategy than the currently recommended <5 ng/L and <6 ng/L cutoffs. This trial is registered with NCT03421873.http://dx.doi.org/10.1155/2024/2241528 |
| spellingShingle | Patrik Gilje Moman A. Mohammad Andreas Roos Ulf Ekelund Jonas Björk Bertil Lindahl Martin Holzmann Arash Mokhtari A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction Emergency Medicine International |
| title | A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction |
| title_full | A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction |
| title_fullStr | A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction |
| title_full_unstemmed | A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction |
| title_short | A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction |
| title_sort | single high sensitivity cardiac troponin t strategy for ruling out myocardial infarction |
| url | http://dx.doi.org/10.1155/2024/2241528 |
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