J H Greenslade1, P Kavsak2, W Parsonage3, C Shortt2, M Than4, J W Pickering5, S Aldous6, L Cullen7. 1. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Australia School of Medicine, The University of Queensland, Australia School of Public Health, Queensland University of Technology, Australia. Electronic address: jaimi.greenslade@health.qld.gov.au. 2. Department of Pathology and Molecular Medicine, McMaster University, Canada. 3. Department of Cardiology, Royal Brisbane and Women's Hospital, Australia School of Medicine, The University of Queensland, Australia School of Public Health, Queensland University of Technology Australia, Australia. 4. Department of Emergency Medicine, Christchurch Hospital, New Zealand. 5. Emergency Care Foundation, Christchurch Hospital, New Zealand. 6. Department of Cardiology, Christchurch Hospital, New Zealand. 7. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Australia School of Medicine, The University of Queensland, Australia School of Public Health, Queensland University of Technology, Australia.
Abstract
BACKGROUND AND AIMS: The use of high sensitivity troponin (hs-Tn) may enable early rule out of acute myocardial infarction (AMI) for patients presenting to the emergency department (ED) with chest pain. This study evaluated two approaches to the early rule out of AMI; a combination of a presentation hs-Tn <4ng/L and normal glucose at presentation (dual testing) and a presentation hs-Tn troponin below the limit of detection (LoD). METHODS: We utilised prospectively collected data on adult patients presenting with suspected ACS in two EDs in Australia and New Zealand. Blood samples were taken on presentation and tested for glucose and high sensitivity troponin I. The primary endpoint was index AMI and the secondary endpoint was 30-day acute coronary syndrome (ACS). Sensitivity, specificity, positive and negative predictive values were used to assess the diagnostic accuracy of the dual testing and LoD approaches. RESULTS: Of the 1412 participants, 182 (12.9%) had index AMI. The LoD and the dual testing approach were 100% sensitive for index AMI. The specificity of the dual testing approach (25.2%) was slightly higher than that of the LoD (20.4%). Sensitivity for ACS was similar for the two approaches (96.5% for dual testing and 98.1% for the LoD). CONCLUSIONS: The dual testing and LoD approach identified all patients with index AMI and could be used to reduce the proportion of patients requiring lengthy assessment and inpatient admission. Further investigation is still required to rule out unstable angina pectoris in patients identified as low risk.
BACKGROUND AND AIMS: The use of high sensitivity troponin (hs-Tn) may enable early rule out of acute myocardial infarction (AMI) for patients presenting to the emergency department (ED) with chest pain. This study evaluated two approaches to the early rule out of AMI; a combination of a presentation hs-Tn <4ng/L and normal glucose at presentation (dual testing) and a presentation hs-Tn troponin below the limit of detection (LoD). METHODS: We utilised prospectively collected data on adult patients presenting with suspected ACS in two EDs in Australia and New Zealand. Blood samples were taken on presentation and tested for glucose and high sensitivity troponin I. The primary endpoint was index AMI and the secondary endpoint was 30-day acute coronary syndrome (ACS). Sensitivity, specificity, positive and negative predictive values were used to assess the diagnostic accuracy of the dual testing and LoD approaches. RESULTS: Of the 1412 participants, 182 (12.9%) had index AMI. The LoD and the dual testing approach were 100% sensitive for index AMI. The specificity of the dual testing approach (25.2%) was slightly higher than that of the LoD (20.4%). Sensitivity for ACS was similar for the two approaches (96.5% for dual testing and 98.1% for the LoD). CONCLUSIONS: The dual testing and LoD approach identified all patients with index AMI and could be used to reduce the proportion of patients requiring lengthy assessment and inpatient admission. Further investigation is still required to rule out unstable angina pectoris in patients identified as low risk.
Authors: Peter A Kavsak; Johannes T Neumann; Louise Cullen; Martin Than; Colleen Shortt; Jaimi H Greenslade; John W Pickering; Francisco Ojeda; Jinhui Ma; Natasha Clayton; Jonathan Sherbino; Stephen A Hill; Matthew McQueen; Dirk Westermann; Nils A Sörensen; William A Parsonage; Lauren Griffith; Shamir R Mehta; P J Devereaux; Mark Richards; Richard Troughton; Chris Pemberton; Sally Aldous; Stefan Blankenberg; Andrew Worster Journal: CMAJ Date: 2018-08-20 Impact factor: 8.262
Authors: Ingar Ziad Restan; Ana Yufera Sanchez; Ole-Thomas Steiro; Pedro Lopez-Ayala; Hilde L Tjora; Jørund Langørgen; Torbjørn Omland; Jasper Boeddinghaus; Thomas Nestelberger; Luca Koechlin; Paul Collinson; Rune Bjørneklett; Kjell Vikenes; Heidi Strand; Øyvind Skadberg; Øistein R Mjelva; Alf Inge Larsen; Vernon V S Bonarjee; Christian Mueller; Kristin M Aakre Journal: Eur Heart J Acute Cardiovasc Care Date: 2022-03-16
Authors: Joanna M Young; John W Pickering; Peter M George; Sally J Aldous; John Wallace; Chris M Frampton; Richard W Troughton; Mark A Richards; Jaimi H Greenslade; Louise Cullen; Martin P Than Journal: BMC Emerg Med Date: 2016-08-31