Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients
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...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
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Elsevier Ireland Ltd.
2015
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| Online Access: | http://hdl.handle.net/20.500.11937/13645 |
| _version_ | 1848748401213046784 |
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| author | Meller, B. Cullen, L. Parsonage, W. Greenslade, J. Aldous, S. Reichlin, T. Wildi, K. Twerenbold, R. Jaeger, C. Hillinger, P. Haaf, P. Puelacher, C. Kern, V. Rentsch, K. Stallone, F. Gimenez, M. Ballarino, P. Bassetti, S. Walukiewicz, A. Troughton, R. Pemberton, C. Richards, M. Chu, Chuan-Wei Reid, Christopher Than, M. Mueller, C. |
| author_facet | Meller, B. Cullen, L. Parsonage, W. Greenslade, J. Aldous, S. Reichlin, T. Wildi, K. Twerenbold, R. Jaeger, C. Hillinger, P. Haaf, P. Puelacher, C. Kern, V. Rentsch, K. Stallone, F. Gimenez, M. Ballarino, P. Bassetti, S. Walukiewicz, A. Troughton, R. Pemberton, C. Richards, M. Chu, Chuan-Wei Reid, Christopher Than, M. Mueller, C. |
| author_sort | Meller, B. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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 Thrombolysis 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. |
| first_indexed | 2025-11-14T07:04:27Z |
| format | Journal Article |
| id | curtin-20.500.11937-13645 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T07:04:27Z |
| publishDate | 2015 |
| publisher | Elsevier Ireland Ltd. |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-136452017-09-13T15:02:43Z Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients Meller, B. Cullen, L. Parsonage, W. Greenslade, J. Aldous, S. Reichlin, T. Wildi, K. Twerenbold, R. Jaeger, C. Hillinger, P. Haaf, P. Puelacher, C. Kern, V. Rentsch, K. Stallone, F. Gimenez, M. Ballarino, P. Bassetti, S. Walukiewicz, A. Troughton, R. Pemberton, C. Richards, M. Chu, Chuan-Wei Reid, Christopher Than, M. Mueller, C. Cardiac troponin ECG MACE TIMI score Acute chest pain 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 Thrombolysis 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. 2015 Journal Article http://hdl.handle.net/20.500.11937/13645 10.1016/j.ijcard.2015.02.006 Elsevier Ireland Ltd. restricted |
| spellingShingle | Cardiac troponin ECG MACE TIMI score Acute chest pain Meller, B. Cullen, L. Parsonage, W. Greenslade, J. Aldous, S. Reichlin, T. Wildi, K. Twerenbold, R. Jaeger, C. Hillinger, P. Haaf, P. Puelacher, C. Kern, V. Rentsch, K. Stallone, F. Gimenez, M. Ballarino, P. Bassetti, S. Walukiewicz, A. Troughton, R. Pemberton, C. Richards, M. Chu, Chuan-Wei Reid, Christopher Than, M. Mueller, C. Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients |
| title | Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients |
| title_full | Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients |
| title_fullStr | Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients |
| title_full_unstemmed | Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients |
| title_short | Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients |
| title_sort | accelerated diagnostic protocol using high-sensitivity cardiac troponin t in acute chest pain patients |
| topic | Cardiac troponin ECG MACE TIMI score Acute chest pain |
| url | http://hdl.handle.net/20.500.11937/13645 |