Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection : A Collaborative Meta-analysis
Pickering, John W ; Than, Martin P ; Cullen, Louise ; Aldous, Sally ; Ter Avest, Ewoud ; Body, Richard ; Carlton, Edward W ; Collinson, Paul ; Dupuy, Anne Marie and Ekelund, Ulf LU
, et al.
(2017)
In Annals of Internal Medicine
166(10).
p.715-724
- Abstract
Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI).
Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain.
Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016).
Study Selection: Cohort studies involving adults presenting to the ED with possible acute coronary syndrome in whom an ECG and hs-cTnT measurements were obtained and AMI outcomes adjudicated during initial hospitalization.
Data... (More)
Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI).
Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain.
Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016).
Study Selection: Cohort studies involving adults presenting to the ED with possible acute coronary syndrome in whom an ECG and hs-cTnT measurements were obtained and AMI outcomes adjudicated during initial hospitalization.
Data Extraction: Investigators of studies provided data on the number of low-risk patients (no new ischemia on ECG and hs-cTnT measurements <0.005 µg/L) and the number who had AMI during hospitalization (primary outcome) or a major adverse cardiac event (MACE) or death within 30 days (secondary outcomes), by risk classification (low or not low risk). Two independent epidemiologists rated risk of bias of studies.
Data Synthesis: Of 9241 patients in 11 cohort studies, 2825 (30.6%) were classified as low risk. Fourteen (0.5%) low-risk patients had AMI. Sensitivity of the risk classification for AMI ranged from 87.5% to 100% in individual studies. Pooled estimated sensitivity was 98.7% (95% CI, 96.6% to 99.5%). Sensitivity for 30-day MACEs ranged from 87.9% to 100%; pooled sensitivity was 98.0% (CI, 94.7% to 99.3%). No low-risk patients died.
Limitation: Few studies, variation in timing and methods of reference standard troponin tests, and heterogeneity of risk and prevalence of AMI across studies.
Conclusion: A single hs-cTnT concentration below the limit of detection in combination with a nonischemic ECG may successfully rule out AMI in patients presenting to EDs with possible emergency acute coronary syndrome.
Primary Funding Source: Emergency Care Foundation.
(Less)
- author
- Pickering, John W
; Than, Martin P
; Cullen, Louise
; Aldous, Sally
; Ter Avest, Ewoud
; Body, Richard
; Carlton, Edward W
; Collinson, Paul
; Dupuy, Anne Marie
and Ekelund, Ulf
LU
, et al. (More)
- Pickering, John W
; Than, Martin P
; Cullen, Louise
; Aldous, Sally
; Ter Avest, Ewoud
; Body, Richard
; Carlton, Edward W
; Collinson, Paul
; Dupuy, Anne Marie
; Ekelund, Ulf
LU
; Eggers, Kai M
; Florkowski, Christopher M
; Freund, Yonathan
; George, Peter
; Goodacre, Steve
; Greenslade, Jaimi H
; Jaffe, Allan S
; Lord, Sarah J
; Mokhtari, Arash
LU
; Mueller, Christian
; Munro, Andrew
; Mustapha, Sebbane
; Parsonage, William
; Peacock, W Frank
; Pemberton, Christopher
; Richards, A Mark
; Sanchis, Juan
; Staub, Lukas P
; Troughton, Richard
; Twerenbold, Raphael
; Wildi, Karin
and Young, Joanna
(Less)
- publishing date
- 2017-05-16
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aged, Chest Pain/etiology, Electrocardiography, Emergency Service, Hospital, Female, Humans, Limit of Detection, Male, Middle Aged, Myocardial Infarction/blood, Troponin T/blood
- in
- Annals of Internal Medicine
- volume
- 166
- issue
- 10
- pages
- 10 pages
- publisher
- American College of Physicians
- external identifiers
-
- pmid:28418520
- scopus:85021639883
- ISSN
- 0003-4819
- DOI
- 10.7326/M16-2562
- language
- English
- LU publication?
- no
- id
- a0c3e5a7-c446-4cbb-b584-046ee5dd7cca
- date added to LUP
- 2019-05-22 13:34:56
- date last changed
- 2024-06-12 15:37:50
@article{a0c3e5a7-c446-4cbb-b584-046ee5dd7cca,
abstract = {{<p>Background: High-sensitivity assays for cardiac troponin T (hs-cTnT) are sometimes used to rapidly rule out acute myocardial infarction (AMI).</p><p>Purpose: To estimate the ability of a single hs-cTnT concentration below the limit of detection (<0.005 µg/L) and a nonischemic electrocardiogram (ECG) to rule out AMI in adults presenting to the emergency department (ED) with chest pain.</p><p>Data Sources: EMBASE and MEDLINE without language restrictions (1 January 2008 to 14 December 2016).</p><p>Study Selection: Cohort studies involving adults presenting to the ED with possible acute coronary syndrome in whom an ECG and hs-cTnT measurements were obtained and AMI outcomes adjudicated during initial hospitalization.</p><p>Data Extraction: Investigators of studies provided data on the number of low-risk patients (no new ischemia on ECG and hs-cTnT measurements <0.005 µg/L) and the number who had AMI during hospitalization (primary outcome) or a major adverse cardiac event (MACE) or death within 30 days (secondary outcomes), by risk classification (low or not low risk). Two independent epidemiologists rated risk of bias of studies.</p><p>Data Synthesis: Of 9241 patients in 11 cohort studies, 2825 (30.6%) were classified as low risk. Fourteen (0.5%) low-risk patients had AMI. Sensitivity of the risk classification for AMI ranged from 87.5% to 100% in individual studies. Pooled estimated sensitivity was 98.7% (95% CI, 96.6% to 99.5%). Sensitivity for 30-day MACEs ranged from 87.9% to 100%; pooled sensitivity was 98.0% (CI, 94.7% to 99.3%). No low-risk patients died.</p><p>Limitation: Few studies, variation in timing and methods of reference standard troponin tests, and heterogeneity of risk and prevalence of AMI across studies.</p><p>Conclusion: A single hs-cTnT concentration below the limit of detection in combination with a nonischemic ECG may successfully rule out AMI in patients presenting to EDs with possible emergency acute coronary syndrome.</p><p>Primary Funding Source: Emergency Care Foundation.</p>}},
author = {{Pickering, John W and Than, Martin P and Cullen, Louise and Aldous, Sally and Ter Avest, Ewoud and Body, Richard and Carlton, Edward W and Collinson, Paul and Dupuy, Anne Marie and Ekelund, Ulf and Eggers, Kai M and Florkowski, Christopher M and Freund, Yonathan and George, Peter and Goodacre, Steve and Greenslade, Jaimi H and Jaffe, Allan S and Lord, Sarah J and Mokhtari, Arash and Mueller, Christian and Munro, Andrew and Mustapha, Sebbane and Parsonage, William and Peacock, W Frank and Pemberton, Christopher and Richards, A Mark and Sanchis, Juan and Staub, Lukas P and Troughton, Richard and Twerenbold, Raphael and Wildi, Karin and Young, Joanna}},
issn = {{0003-4819}},
keywords = {{Aged; Chest Pain/etiology; Electrocardiography; Emergency Service, Hospital; Female; Humans; Limit of Detection; Male; Middle Aged; Myocardial Infarction/blood; Troponin T/blood}},
language = {{eng}},
month = {{05}},
number = {{10}},
pages = {{715--724}},
publisher = {{American College of Physicians}},
series = {{Annals of Internal Medicine}},
title = {{Rapid Rule-out of Acute Myocardial Infarction With a Single High-Sensitivity Cardiac Troponin T Measurement Below the Limit of Detection : A Collaborative Meta-analysis}},
url = {{http://dx.doi.org/10.7326/M16-2562}},
doi = {{10.7326/M16-2562}},
volume = {{166}},
year = {{2017}},
}