Author + information
- Dennis Sandemana,b,
- Anoop Shaha,b,
- Lorraine Dinnela,b,
- Jack Andrewsa,b,
- Bappa Roya,b,
- Philip Wenhama,b,
- Ken Campbella,b,
- Mary Jarviea,b,
- Atul Ananda,b,
- Robert Cargilla,b,
- Mark Francisa,b,
- Andrew Chapmana,b and
- Nicholas Millsa,b
Background: Whilst the majority of patients with chest pain presenting to the Emergency Department do not have myocardial infarction (MI), most are admitted for serial cardiac troponin testing. High-sensitivity cardiac troponin assays may improve the risk stratification of patients at presentation and reduce unnecessary hospitalisation.
Methods: We prospectively identified 2,651 consecutive patients with suspected acute coronary syndrome who had serial cardiac troponin testing from November 2014 to March 2016 at a secondary care hospital in Scotland. High-sensitivity cardiac troponin T concentrations were measured at presentation and at 6-12 hours. We evaluated a range of troponin concentrations at presentation to define the negative predictive value (NPV) for an index diagnosis of MI (troponin >14 ng/L and change >10 ng/L) or MI within 30 days.
Results: Index MI was diagnosed in 23% (608/2,651) patients. Cardiac troponin T concentrations were <5 ng/L at presentation in 24% (646/2,651). In those patients with troponin concentration <5 ng/L at presentation the NPV was 99.2% (95% confidence intervals [CI] 98.4 to 99.8%) for the primary outcome, missing 5 index events and one MI at 30 days. Lower NPVs were observed for concentrations >5 ng/L at presentation (Figure).
Conclusions: High-sensitivity cardiac troponin T concentrations <5 ng/L at presentation identify one quarter of patients with suspected acute coronary syndrome as low risk and could be safely incorporated into early rule-out pathways.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-341
- 2017 American College of Cardiology Foundation