Adding historical high-sensitivity troponin T results to rule out acute myocardial infarction
Roos, Andreas ; Mohammad, Moman A LU ; Ekelund, Ulf LU
; Mokhtari, Arash
LU
and Holzmann, Martin J
(2022)
In European Heart Journal: Acute Cardiovascular Care
11(3).
p.215-223
- Abstract
AIMS: The clinical usefulness of historical concentrations of high-sensitivity cardiac troponin T (hs-cTnT) is unknown. This study investigated the ability to rule out myocardial infarction (MI) with the use of historical hs-cTnT concentrations among patients with chest pain in the emergency department (ED).
METHODS AND RESULTS: The derivation cohort consisted of patients presenting with chest pain to nine different EDs (n = 60 071), where we included those with ≥1 hs-cTnT analysed at the index visit and ≥1 hs-cTnT results prior to the visit. We developed an algorithm to rule out MI within 30 days with a pre-specified target negative predictive value (NPV) of ≥99.5%. The performance was then validated in a separate cohort of ED... (More)
AIMS: The clinical usefulness of historical concentrations of high-sensitivity cardiac troponin T (hs-cTnT) is unknown. This study investigated the ability to rule out myocardial infarction (MI) with the use of historical hs-cTnT concentrations among patients with chest pain in the emergency department (ED).
METHODS AND RESULTS: The derivation cohort consisted of patients presenting with chest pain to nine different EDs (n = 60 071), where we included those with ≥1 hs-cTnT analysed at the index visit and ≥1 hs-cTnT results prior to the visit. We developed an algorithm to rule out MI within 30 days with a pre-specified target negative predictive value (NPV) of ≥99.5%. The performance was then validated in a separate cohort of ED chest pain patients (n = 10 994). A historical hs-cTnT < 12 ng/L and a < 3 ng/L absolute change between the historical and the index visit hs-cTnT had the best performance and ruled out 24 862 (41%) patients in the derivation cohort. In the validation cohort, these criteria identified 4764 (43%) low-risk patients in whom 18 (0.4%) MIs within 30 days occurred, and had an NPV for MI of 99.6% (99.4-99.8), a sensitivity of 96.9% (95.2-.2), and an LR- of 0.11 (0.07-0.14).
CONCLUSION: Combining a historical hs-cTnT with a single new hs-cTnT may safely rule out MI and thereby reduce the need for serial hs-cTnT measurements in ED patients with chest pain.
(Less)
- author
- Roos, Andreas
; Mohammad, Moman A
LU
; Ekelund, Ulf
LU
; Mokhtari, Arash
LU
and Holzmann, Martin J
- organization
- publishing date
- 2022-03-16
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Biomarkers, Chest Pain/diagnosis, Emergency Service, Hospital, Humans, Myocardial Infarction/diagnosis, Predictive Value of Tests, Troponin T
- in
- European Heart Journal: Acute Cardiovascular Care
- volume
- 11
- issue
- 3
- pages
- 215 - 223
- publisher
- Oxford University Press
- external identifiers
-
- pmid:34977928
- scopus:85137290287
- ISSN
- 2048-8734
- DOI
- 10.1093/ehjacc/zuab123
- language
- English
- LU publication?
- yes
- additional info
- Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2022. For permissions, please email: journals.permissions@oup.com.
- id
- ef680dc5-9df7-49d3-9fa6-6c1abdd0cdfc
- date added to LUP
- 2022-09-18 23:07:16
- date last changed
- 2024-04-05 17:28:01
@article{ef680dc5-9df7-49d3-9fa6-6c1abdd0cdfc,
abstract = {{<p>AIMS: The clinical usefulness of historical concentrations of high-sensitivity cardiac troponin T (hs-cTnT) is unknown. This study investigated the ability to rule out myocardial infarction (MI) with the use of historical hs-cTnT concentrations among patients with chest pain in the emergency department (ED).</p><p>METHODS AND RESULTS: The derivation cohort consisted of patients presenting with chest pain to nine different EDs (n = 60 071), where we included those with ≥1 hs-cTnT analysed at the index visit and ≥1 hs-cTnT results prior to the visit. We developed an algorithm to rule out MI within 30 days with a pre-specified target negative predictive value (NPV) of ≥99.5%. The performance was then validated in a separate cohort of ED chest pain patients (n = 10 994). A historical hs-cTnT < 12 ng/L and a < 3 ng/L absolute change between the historical and the index visit hs-cTnT had the best performance and ruled out 24 862 (41%) patients in the derivation cohort. In the validation cohort, these criteria identified 4764 (43%) low-risk patients in whom 18 (0.4%) MIs within 30 days occurred, and had an NPV for MI of 99.6% (99.4-99.8), a sensitivity of 96.9% (95.2-.2), and an LR- of 0.11 (0.07-0.14).</p><p>CONCLUSION: Combining a historical hs-cTnT with a single new hs-cTnT may safely rule out MI and thereby reduce the need for serial hs-cTnT measurements in ED patients with chest pain.</p>}},
author = {{Roos, Andreas and Mohammad, Moman A and Ekelund, Ulf and Mokhtari, Arash and Holzmann, Martin J}},
issn = {{2048-8734}},
keywords = {{Biomarkers; Chest Pain/diagnosis; Emergency Service, Hospital; Humans; Myocardial Infarction/diagnosis; Predictive Value of Tests; Troponin T}},
language = {{eng}},
month = {{03}},
number = {{3}},
pages = {{215--223}},
publisher = {{Oxford University Press}},
series = {{European Heart Journal: Acute Cardiovascular Care}},
title = {{Adding historical high-sensitivity troponin T results to rule out acute myocardial infarction}},
url = {{http://dx.doi.org/10.1093/ehjacc/zuab123}},
doi = {{10.1093/ehjacc/zuab123}},
volume = {{11}},
year = {{2022}},
}