BACKGROUND: Assessment of non-cardiac chest pain places a considerable burden on healthcare resources. The current practice of serial electrocardiographs (ECGs), serum creatinine phosphokinase and by pre-discharge exercise electrocardiography gives an average in-hospital stay of 3.7 days. AIMS: This study assess the use of a sensitive assay for cardiac troponin I (cTnI) to identify a low risk group for whom exercise ECG may not be indicated. METHOD: Ninety-five patients with acute chest pain and with peak cTnI < 0.1 ng/ml and a non-diagnostic resting ECG were studied. Patients were divided into two groups. Group one had normal range cTnI (< 0.03 ng/ml). Group two had minimal elevation of cTnI (0.03-0.099 ng/ml). Average follow-up was 172 days. RESULTS: Nineteen patients had minimal elevation in cTnI of whom five developed significant ST shift on exercise and five had adverse events. No patient with a normal range cTnI had a positive stress test and none suffered an adverse event (p < 0.001). CONCLUSION: CTnI in the normal range can identify patients with acute chest pain who have a negligible event rate and for whom exercise electrocardiography is not required.
BACKGROUND: Assessment of non-cardiac chest pain places a considerable burden on healthcare resources. The current practice of serial electrocardiographs (ECGs), serum creatinine phosphokinase and by pre-discharge exercise electrocardiography gives an average in-hospital stay of 3.7 days. AIMS: This study assess the use of a sensitive assay for cardiac troponin I (cTnI) to identify a low risk group for whom exercise ECG may not be indicated. METHOD: Ninety-five patients with acute chest pain and with peak cTnI < 0.1 ng/ml and a non-diagnostic resting ECG were studied. Patients were divided into two groups. Group one had normal range cTnI (< 0.03 ng/ml). Group two had minimal elevation of cTnI (0.03-0.099 ng/ml). Average follow-up was 172 days. RESULTS: Nineteen patients had minimal elevation in cTnI of whom five developed significant ST shift on exercise and five had adverse events. No patient with a normal range cTnI had a positive stress test and none suffered an adverse event (p < 0.001). CONCLUSION:CTnI in the normal range can identify patients with acute chest pain who have a negligible event rate and for whom exercise electrocardiography is not required.
Authors: J P Bertinchant; C Larue; I Pernel; B Ledermann; P Fabbro-Peray; L Beck; C Calzolari; S Trinquier; J Nigond; B Pau Journal: Clin Biochem Date: 1996-12 Impact factor: 3.281
Authors: R H Christenson; F S Apple; D L Morgan; G L Alonsozana; K Mascotti; M Olson; R T McCormack; F H Wians; J H Keffer; S H Duh Journal: Clin Chem Date: 1998-01 Impact factor: 8.327
Authors: R J Zalenski; M McCarren; R Roberts; R J Rydman; B Jovanovic; K Das; J Mendez; M el-Khadra; L Fraker; M McDermott Journal: Arch Intern Med Date: 1997-05-26
Authors: R Gianrossi; R Detrano; D Mulvihill; K Lehmann; P Dubach; A Colombo; D McArthur; V Froelicher Journal: Circulation Date: 1989-07 Impact factor: 29.690