Glucose and high-sensitivity troponin T predict a low risk of major adverse cardiac events in emergency department chest pain patients
(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.
(Less)
- author
- Olsson, Pontus
LU
; Khoshnood, Ardavan
LU
; Mokhtari, Arash LU and Ekelund, Ulf LU
- organization
- publishing date
- 2021-10-07
- 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
-
- scopus:85116594045
- pmid:34617492
- 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
- 2025-01-13 14:51:28
@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 <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.</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}}, }