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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction

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Development of an algorithm for ruling-out non-ST elevation myocardial infarction in the emergency department using

Fabrizio Cappellini1, Rosanna Falbo2, Donata Saltafossi3

  • 1University Department of Laboratory Medicine, ASST Monza, Hospital San Gerardo, Via G. Pergolesi 33, 20900 Monza, MB, Italy.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|March 27, 2019
PubMed

Insights

This study developed a safe and fast algorithm to rule out non-ST elevation myocardial infarction (NSTEMI) in emergency department patients using high-sensitivity cardiac troponin T (hs-cTnT) levels. A baseline hs-cTnT below 14 ng/L allows for early NSTEMI exclusion.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Biomarker Analysis

Background:

  • Chest pain is a frequent emergency department (ED) presentation.
  • Acute myocardial infarction (AMI) diagnosis requires rapid assessment to avoid delays in low-risk patients.
  • Cardiac troponins are crucial for safely ruling out AMI in the ED.

Purpose of the Study:

  • To develop and validate an algorithm for the early rule-out of non-ST elevation myocardial infarction (NSTEMI).
  • To improve the management of patients presenting to the ED with symptoms suggestive of myocardial infarction.

Main Methods:

  • Utilized high-sensitivity cardiac Troponin T (hs-cTnT) serial measurements (baseline, 1-hour, and 3-hour).
  • Developed and validated the algorithm in large cohorts (6403 and 773 admissions).
  • Employed Receiver Operating Characteristic (ROC) curve analysis to determine optimal hs-cTnT thresholds.

Main Results:

  • Identified changes in serial hs-cTnT measurements for near 100% diagnostic sensitivity.
  • Established a baseline hs-cTnT level below 14 ng/L as a criterion for safe NSTEMI rule-out.
  • Classified patients based on clinical assessment, imaging, and hs-cTnT levels.

Conclusions:

  • Algorithms for rapid NSTEMI rule-out are feasible and safe.
  • Further refinements are needed, but the approach shows promise for efficient ED patient management.
  • Early identification of low-risk NSTEMI patients can optimize resource allocation and patient flow.
Abstract

Keywords:
AMICardiac troponinChest painHs-cTnTNSTEMIRule-out

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