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A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction

Gilje, Patrik LU ; Mohammad, Moman A. LU ; Roos, Andreas ; Ekelund, Ulf LU orcid ; Björk, Jonas LU ; Lindahl, Bertil ; Holzmann, Martin and Mokhtari, Arash LU (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
; ; ; ; ; ; and
organization
publishing date
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
2024-07-05 15:56:44
@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) &lt;5 ng/L or &lt;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 &lt;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 &lt;5 ng/L and &lt;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 &gt;3 h after symptom onset and in those with a nonischemic ECG and nonhigh risk history. Conclusions. A 0 h hs-cTnT cutoff of &lt;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 &lt;5 ng/L and &lt;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}},
}