Adding historical high-sensitivity troponin T results to rule out acute myocardial infarction
Andreas Roos1,2, Moman A Mohammad3, Ulf Ekelund4
1Department of Medicine Solna, Framstegsgatan 21, Building D1:04, Karolinska Institutet, SE-171 64 Solna, Stockholm, Sweden.
Insights
Historical high-sensitivity cardiac troponin T (hs-cTnT) levels can safely rule out myocardial infarction (MI) in emergency department patients. This approach may reduce the need for serial hs-cTnT testing in chest pain evaluations.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Research
Background:
- The clinical utility of historical high-sensitivity cardiac troponin T (hs-cTnT) concentrations for diagnosing myocardial infarction (MI) is not well-established.
- Accurate and efficient risk stratification of emergency department (ED) patients presenting with chest pain is crucial.
Purpose of the Study:
- To investigate the effectiveness of historical hs-cTnT concentrations in ruling out MI among ED patients with chest pain.
- To develop and validate an algorithm using historical hs-cTnT to identify low-risk patients.
Main Methods:
- A derivation cohort of 60,071 ED patients with chest pain and at least one historical and one index hs-cTnT measurement was analyzed.
- An algorithm was developed to rule out MI within 30 days, targeting a negative predictive value (NPV) of ≥99.5%.
- The algorithm's performance was validated in a separate cohort of 10,994 ED chest pain patients.
Main Results:
- An algorithm combining a historical hs-cTnT < 12 ng/L and an absolute change < 3 ng/L between historical and index measurements demonstrated optimal performance.
- This algorithm ruled out 41% of patients in the derivation cohort and identified 43% of low-risk patients in the validation cohort.
- In the validation cohort, this strategy resulted in an MI NPV of 99.6% and identified 18 MIs (0.4%) within 30 days.
Conclusions:
- The combination of historical and a single new hs-cTnT measurement can safely rule out MI in ED patients with chest pain.
- This strategy has the potential to significantly reduce the need for serial hs-cTnT measurements, improving ED workflow.
- Utilizing historical hs-cTnT data offers a valuable tool for efficient MI rule-out in the emergency setting.
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.
More Related Videos
07:40Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training
Published on: October 10, 2019
10:12A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Imaging Studies for Cardiovascular System V: CT