A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction
(2024) In Emergency Medicine International 2024.- Abstract
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... (More)
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.
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- author
- Gilje, Patrik LU ; Mohammad, Moman A. LU ; Roos, Andreas ; Ekelund, Ulf LU ; Björk, Jonas LU ; Lindahl, Bertil ; Holzmann, Martin and Mokhtari, Arash LU
- organization
-
- Molecular Cardiology (research group)
- Emergency medicine (research group)
- EpiHealth: Epidemiology for Health
- Division of Occupational and Environmental Medicine, Lund University
- eSSENCE: The e-Science Collaboration
- EPI@LUND (research group)
- LU Profile Area: Nature-based future solutions
- NPWT technology (research group)
- Less invasive cardiac surgery (research group)
- Cardiology
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Emergency Medicine International
- volume
- 2024
- article number
- 2241528
- publisher
- Hindawi Limited
- external identifiers
-
- pmid:38567081
- scopus:85189982230
- ISSN
- 2090-2840
- DOI
- 10.1155/2024/2241528
- project
- AIR Lund - Artificially Intelligent use of Registers
- language
- English
- LU publication?
- yes
- id
- 39208f8d-a58b-4aa0-9a84-b002dc86986a
- date added to LUP
- 2024-04-26 10:12:14
- date last changed
- 2024-07-19 19:08:08
@article{39208f8d-a58b-4aa0-9a84-b002dc86986a, abstract = {{<p>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.</p>}}, author = {{Gilje, Patrik and Mohammad, Moman A. and Roos, Andreas and Ekelund, Ulf and Björk, Jonas and Lindahl, Bertil and Holzmann, Martin and Mokhtari, Arash}}, issn = {{2090-2840}}, language = {{eng}}, publisher = {{Hindawi Limited}}, series = {{Emergency Medicine International}}, title = {{A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction}}, url = {{http://dx.doi.org/10.1155/2024/2241528}}, doi = {{10.1155/2024/2241528}}, volume = {{2024}}, year = {{2024}}, }