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Glucose and high-sensitivity troponin T predict a low risk of major adverse cardiac events in emergency department chest pain patients

Olsson, Pontus LU ; Khoshnood, Ardavan LU orcid ; Mokhtari, Arash LU and Ekelund, Ulf LU orcid (2021) In Scandinavian cardiovascular journal : SCJ 55(6). p.354-361
Abstract

Background. Glucose is emerging as a biomarker for early and safe rule-out of acute myocardial infarction in emergency department (ED) chest pain patients. We evaluated the diagnostic accuracy of dual testing with high sensitivity TnT (hs-cTnT) and glucose for prediction of major adverse cardiac events (MACE) within 30 days. Methods. This was a secondary analysis of a single-center prospective observational study of 1167 ED chest-pain patients with hs-cTnT and glucose testing at presentation (0 h), and hs-cTnT 1 h later. We tested the addition of glucose <5.6 mmol/L to three MACE rule-out strategies: hs-cTnT <5 ng/L, ≤14 ng/L or a 0 h/1h algorithm, i.e. initial hs-cTnT <12 ng/L with a 1 h change of <3 ng/L. We also tested... (More)

Background. Glucose is emerging as a biomarker for early and safe rule-out of acute myocardial infarction in emergency department (ED) chest pain patients. We evaluated the diagnostic accuracy of dual testing with high sensitivity TnT (hs-cTnT) and glucose for prediction of major adverse cardiac events (MACE) within 30 days. Methods. This was a secondary analysis of a single-center prospective observational study of 1167 ED chest-pain patients with hs-cTnT and glucose testing at presentation (0 h), and hs-cTnT 1 h later. We tested the addition of glucose <5.6 mmol/L to three MACE rule-out strategies: hs-cTnT <5 ng/L, ≤14 ng/L or a 0 h/1h algorithm, i.e. initial hs-cTnT <12 ng/L with a 1 h change of <3 ng/L. We also tested the addition of glucose ≥11mmol/L to three rule-in strategies: hs-cTnT ≥52 ng/L, a 1 h change ≥5 ng/L or hs-cTnT >14 ng/L. The outcomes were 30-day MACE and 30-day MACE without UA. Results. Two dual-testing approaches reached our target NPV for rule-out: A 0 h hs-cTnT ≤14 ng/L and glucose <5.6 mmol/L identified 252 patients (24.4%) with a 98.8% NPV for 30-day MACE and 99.6% for MACE without UA. The 0 h/1h hs-cTnT algorithm combined with glucose identified 240 patients (23.2%) with a 99.2% NPV for 30-day MACE and 100.0% for MACE without UA. No dual rule-in strategy performed better than using hs-cTnT alone. Conclusions. A combination of hs-cTnT and blood glucose at presentation can be used to identify almost ¼ of ED chest pain patients with a very low risk of 30-day MACE where further testing is not needed. Adding glucose did not improve the rule-in of 30-day MACE.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Troponin, Glucose, Cardiology, Emergency Medicine, Troponin, Glukos, Kardiologi, Akutsjukvård
in
Scandinavian cardiovascular journal : SCJ
volume
55
issue
6
pages
354 - 361
publisher
Taylor & Francis
external identifiers
  • pmid:34617492
  • scopus:85116594045
ISSN
1651-2006
DOI
10.1080/14017431.2021.1987512
project
AIR Lund - Artificially Intelligent use of Registers
language
English
LU publication?
yes
id
2ebf70dc-b7aa-4941-bfac-16810aeab241
date added to LUP
2021-10-09 23:58:09
date last changed
2024-06-15 17:45:59
@article{2ebf70dc-b7aa-4941-bfac-16810aeab241,
  abstract     = {{<p>Background. Glucose is emerging as a biomarker for early and safe rule-out of acute myocardial infarction in emergency department (ED) chest pain patients. We evaluated the diagnostic accuracy of dual testing with high sensitivity TnT (hs-cTnT) and glucose for prediction of major adverse cardiac events (MACE) within 30 days. Methods. This was a secondary analysis of a single-center prospective observational study of 1167 ED chest-pain patients with hs-cTnT and glucose testing at presentation (0 h), and hs-cTnT 1 h later. We tested the addition of glucose &lt;5.6 mmol/L to three MACE rule-out strategies: hs-cTnT &lt;5 ng/L, ≤14 ng/L or a 0 h/1h algorithm, i.e. initial hs-cTnT &lt;12 ng/L with a 1 h change of &lt;3 ng/L. We also tested the addition of glucose ≥11mmol/L to three rule-in strategies: hs-cTnT ≥52 ng/L, a 1 h change ≥5 ng/L or hs-cTnT &gt;14 ng/L. The outcomes were 30-day MACE and 30-day MACE without UA. Results. Two dual-testing approaches reached our target NPV for rule-out: A 0 h hs-cTnT ≤14 ng/L and glucose &lt;5.6 mmol/L identified 252 patients (24.4%) with a 98.8% NPV for 30-day MACE and 99.6% for MACE without UA. The 0 h/1h hs-cTnT algorithm combined with glucose identified 240 patients (23.2%) with a 99.2% NPV for 30-day MACE and 100.0% for MACE without UA. No dual rule-in strategy performed better than using hs-cTnT alone. Conclusions. A combination of hs-cTnT and blood glucose at presentation can be used to identify almost ¼ of ED chest pain patients with a very low risk of 30-day MACE where further testing is not needed. Adding glucose did not improve the rule-in of 30-day MACE.</p>}},
  author       = {{Olsson, Pontus and Khoshnood, Ardavan and Mokhtari, Arash and Ekelund, Ulf}},
  issn         = {{1651-2006}},
  keywords     = {{Troponin; Glucose; Cardiology; Emergency Medicine; Troponin; Glukos; Kardiologi; Akutsjukvård}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{6}},
  pages        = {{354--361}},
  publisher    = {{Taylor & Francis}},
  series       = {{Scandinavian cardiovascular journal : SCJ}},
  title        = {{Glucose and high-sensitivity troponin T predict a low risk of major adverse cardiac events in emergency department chest pain patients}},
  url          = {{http://dx.doi.org/10.1080/14017431.2021.1987512}},
  doi          = {{10.1080/14017431.2021.1987512}},
  volume       = {{55}},
  year         = {{2021}},
}