Camille Chenevier-Gobeaux1, Christophe Meune2, Guillaume Lefevre3, Benoit Doumenc4, Emmanuel Sorbets2, Nicolas Peschanski5, Patrick Ray6. 1. Department of Automated Biological Diagnosis, Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), 75014 Paris Cedex, France. Electronic address: camille.gobeaux@cch.aphp.fr. 2. Department of Cardiology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine Saint Denis, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, Université Paris 13, UMR S-942, Paris, France. 3. Department of Biochemistry and Hormonology, Hôpital Tenon, Hôpitaux Universitaires est Parisiens (HUEP), Assistance Publique des Hôpitaux de Paris (AP-HP), 4 Rue de la Chine, 75020 Paris, France. 4. Department of Emergency Medicine, Hôpital Cochin, Hôpitaux Universitaires Paris Centre (HUPC), Assistance Publique des Hôpitaux de Paris (AP-HP), 75014 Paris Cedex, France; Université Paris Descartes, France. 5. Department of Emergency Medicine, Hôpital Tenon, Hôpitaux Universitaires est Parisiens (HUEP), Assistance Publique des Hôpitaux de Paris (AP-HP), 4 Rue de la Chine, 75020 Paris, France. 6. Department of Emergency Medicine, Hôpital Tenon, Hôpitaux Universitaires est Parisiens (HUEP), Assistance Publique des Hôpitaux de Paris (AP-HP), 4 Rue de la Chine, 75020 Paris, France; Sorbonne Universités UMPC Université Paris 06, Paris, DHU Fighting Aging and Stress (FAST) Université Pierre et Marie Curie Paris 6, France.
Abstract
BACKGROUND: Recent 2015 ESC recommendations for the management of patients with suspected acute myocardial infarction (AMI) support that a single value of high-sensitivity cardiac troponin (HS-cTn) measured at presentation could rule out AMI if below the limit of blank (LoB) or detection (LoD). OBJECTIVES: We aimed to evaluate whether an undetectable HS-cTnT at presentation safely rules out NSTEMI in unselected patients with chest pain. PATIENTS AND METHODS: This is a post hoc analysis of two prospective cohorts with similar design that included patients suspected of AMI at three French university hospitals. Patients were followed-up during one month, before the adjudication of a final diagnosis. RESULTS: 413 patients (mean age 58±17years) were analyzed; 45 (11%) had a final diagnosis of NSTEMI, and 26 (6%) had STEMI. The sensitivity of HS-cTnT value at 3ng/L (LoB) for NSTEMI was 97.8% [95% CI: 86.8-99.9], yielding a negative predictive value (NPV) of 99.3% [95% CI: 95.4-100.0]. Proportion of patients ruled out for NSTEMI was 32% when applying the LoB. The sensitivity of HS-cTnT value at 5ng/L (LoD) was 97.8% [95% CI: 86.8-99.9] yielding a NPV of 99.5% [95% CI: 96.5-100.0]. Proportion of patients ruled out for NSTEMI was 43% when applying the LoD. One patient (delay between onset of chest pain and presentation <3h) had NSTEMI and HS-cTnT <LoB at presentation. CONCLUSION: The NPV of a single measurement of HS-cTnT below the LoD is high in unselected patients, but not enough to rule out safely NSTEMI for very early presenters.
BACKGROUND: Recent 2015 ESC recommendations for the management of patients with suspected acute myocardial infarction (AMI) support that a single value of high-sensitivity cardiac troponin (HS-cTn) measured at presentation could rule out AMI if below the limit of blank (LoB) or detection (LoD). OBJECTIVES: We aimed to evaluate whether an undetectable HS-cTnT at presentation safely rules out NSTEMI in unselected patients with chest pain. PATIENTS AND METHODS: This is a post hoc analysis of two prospective cohorts with similar design that included patients suspected of AMI at three French university hospitals. Patients were followed-up during one month, before the adjudication of a final diagnosis. RESULTS: 413 patients (mean age 58±17years) were analyzed; 45 (11%) had a final diagnosis of NSTEMI, and 26 (6%) had STEMI. The sensitivity of HS-cTnT value at 3ng/L (LoB) for NSTEMI was 97.8% [95% CI: 86.8-99.9], yielding a negative predictive value (NPV) of 99.3% [95% CI: 95.4-100.0]. Proportion of patients ruled out for NSTEMI was 32% when applying the LoB. The sensitivity of HS-cTnT value at 5ng/L (LoD) was 97.8% [95% CI: 86.8-99.9] yielding a NPV of 99.5% [95% CI: 96.5-100.0]. Proportion of patients ruled out for NSTEMI was 43% when applying the LoD. One patient (delay between onset of chest pain and presentation <3h) had NSTEMI and HS-cTnT <LoB at presentation. CONCLUSION: The NPV of a single measurement of HS-cTnT below the LoD is high in unselected patients, but not enough to rule out safely NSTEMI for very early presenters.
Authors: Camille Chenevier-Gobeaux; Mustapha Sebbane; Christophe Meune; Sophie Lefebvre; Anne-Marie Dupuy; Guillaume Lefèvre; Nicolas Peschanski; Patrick Ray Journal: BMJ Open Date: 2019-06-16 Impact factor: 2.692
Authors: Jack Marjot; Thomas E Kaier; Eva D Martin; Shiney S Reji; O'Neal Copeland; Mohammed Iqbal; Bob Goodson; Sarah Hamren; Sian E Harding; Michael S Marber Journal: Clin Chem Date: 2017-04-04 Impact factor: 8.327
Authors: James E Andruchow; Timothy Boyne; Grant Innes; Shabnam Vatanpour; Isolde Seiden-Long; Dongmei Wang; Eddy Lang; Andrew D McRae Journal: CJC Open Date: 2019-08-27