Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events
MOKHTARI, ARASH LU ; Lindahl, Bertil ; Smith, J. Gustav ; Holzmann, Martin J. ; Khoshnood, Ardavan LU
and Ekelund, Ulf
LU
(2016)
In Annals of Emergency Medicine
68(6).
p.649-658
- Abstract
Study objective: We evaluate the diagnostic accuracy of a high-sensitivity cardiac troponin T (hs-cTnT) level less than 5 ng/L or less than or equal to 14 ng/L at emergency department (ED) presentation, combined with the emergency physician's assessment of history and ECG, for ruling out major adverse cardiac events within 30 days. Methods: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians' assessments of patient history and ECG were collected. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause.... (More)
Study objective: We evaluate the diagnostic accuracy of a high-sensitivity cardiac troponin T (hs-cTnT) level less than 5 ng/L or less than or equal to 14 ng/L at emergency department (ED) presentation, combined with the emergency physician's assessment of history and ECG, for ruling out major adverse cardiac events within 30 days. Methods: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians' assessments of patient history and ECG were collected. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause. Results: A total of 1,138 patients were included in the final analysis. The combination of hs-cTnT less than 5 ng/L, a nonischemic ECG result, and a nonhigh risk history was present for 29.2% of all patients and had a sensitivity of 99.2% (95% confidence interval [CI] 95.6% to 100%), negative predictive value (NPV) of 99.7% (95% CI 98.3% to 100%), and a negative likelihood ratio of 0.02 (95% CI 0 to 0.17) for 30-day major adverse cardiac events. The same combination with hs-cTnT less than or equal to 14 ng/L was present in 66.7% of the patients and had a sensitivity of 92% (95% CI 85.8% to 96.1%), NPV of 98.7% (95% CI 97.6% to 99.4%), and negative likelihood ratio of 0.11 (95% CI 0.06 to 0.20). Conclusion: A single hs-cTnT result of less than 5 ng/L at ED presentation when combined with a nonischemic ECG result and a nonhigh risk history identified 29% of chest pain patients at a very low risk of 30-day major adverse cardiac events. A similar strategy with hs-cTnT less than or equal to 14 ng/L was associated with a higher miss rate.
(Less)
- author
- MOKHTARI, ARASH
LU
; Lindahl, Bertil
; Smith, J. Gustav
; Holzmann, Martin J.
; Khoshnood, Ardavan
LU
and Ekelund, Ulf
LU
- organization
- publishing date
- 2016-03-25
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- TnT, Troponin T, Chest Pain, Acute Coronary Syndrome, Myocardial Infarction, TnT, Troponin T, Bröstsmärta, Akut Koronart Syndrom, Hjärtinfarkt
- in
- Annals of Emergency Medicine
- volume
- 68
- issue
- 6
- pages
- 10 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:27471140
- wos:000389164800003
- scopus:84979707948
- ISSN
- 0196-0644
- DOI
- 10.1016/j.annemergmed.2016.06.008
- project
- AIR Lund Chest pain - More efficient and equal emergency care with advanced medical decision support tools
- language
- English
- LU publication?
- yes
- id
- 3a628132-8a29-4efe-ac4e-56aecb3a3224
- date added to LUP
- 2016-09-08 15:53:25
- date last changed
- 2025-01-12 11:05:37
@article{3a628132-8a29-4efe-ac4e-56aecb3a3224,
abstract = {{<p>Study objective: We evaluate the diagnostic accuracy of a high-sensitivity cardiac troponin T (hs-cTnT) level less than 5 ng/L or less than or equal to 14 ng/L at emergency department (ED) presentation, combined with the emergency physician's assessment of history and ECG, for ruling out major adverse cardiac events within 30 days. Methods: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians' assessments of patient history and ECG were collected. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause. Results: A total of 1,138 patients were included in the final analysis. The combination of hs-cTnT less than 5 ng/L, a nonischemic ECG result, and a nonhigh risk history was present for 29.2% of all patients and had a sensitivity of 99.2% (95% confidence interval [CI] 95.6% to 100%), negative predictive value (NPV) of 99.7% (95% CI 98.3% to 100%), and a negative likelihood ratio of 0.02 (95% CI 0 to 0.17) for 30-day major adverse cardiac events. The same combination with hs-cTnT less than or equal to 14 ng/L was present in 66.7% of the patients and had a sensitivity of 92% (95% CI 85.8% to 96.1%), NPV of 98.7% (95% CI 97.6% to 99.4%), and negative likelihood ratio of 0.11 (95% CI 0.06 to 0.20). Conclusion: A single hs-cTnT result of less than 5 ng/L at ED presentation when combined with a nonischemic ECG result and a nonhigh risk history identified 29% of chest pain patients at a very low risk of 30-day major adverse cardiac events. A similar strategy with hs-cTnT less than or equal to 14 ng/L was associated with a higher miss rate.</p>}},
author = {{MOKHTARI, ARASH and Lindahl, Bertil and Smith, J. Gustav and Holzmann, Martin J. and Khoshnood, Ardavan and Ekelund, Ulf}},
issn = {{0196-0644}},
keywords = {{TnT; Troponin T; Chest Pain; Acute Coronary Syndrome; Myocardial Infarction; TnT; Troponin T; Bröstsmärta; Akut Koronart Syndrom; Hjärtinfarkt}},
language = {{eng}},
month = {{03}},
number = {{6}},
pages = {{649--658}},
publisher = {{Elsevier}},
series = {{Annals of Emergency Medicine}},
title = {{Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events}},
url = {{http://dx.doi.org/10.1016/j.annemergmed.2016.06.008}},
doi = {{10.1016/j.annemergmed.2016.06.008}},
volume = {{68}},
year = {{2016}},
}