Richard Nowak1, Christian Mueller2, Evangelos Giannitsis3, Michael Christ4, Jordi Ordonez-Llanos5, Christopher DeFilippi6, James McCord7, Richard Body8, Mauro Panteghini9, Tomas Jernberg10, Mario Plebani11, Franck Verschuren12, John K French13, Robert Christenson14, Gordon Jacobsen15, Carina Dinkel16, Bertil Lindahl17. 1. a Emergency Medicine , Henry Ford Hospital , Detroit , MI , USA. 2. b Department of Cardiology & Cardiovascular Research Institute Basel , University Hospital Base , Basel , Switzerland. 3. c Department of Internal Medicine, Cardiology, Angiology & Pulmonary , University Hospital Heidelberg , Heidelberg , Germany. 4. d Department of Emergency and Critical Care Medicine , Paracelsus Medical University , Germany , Nuernberg. 5. e Biochemistry , Hospital de Sant Pau , Barcelona , UK. 6. f Cardiology , University of Maryland , Baltimore , MD , USA. 7. g Cardiology , Henry Ford Hospital , Detroit , MI , USA. 8. h Emergency Medicine , Central Manchester University NHS Foundation Trust , Manchester , UK. 9. i Laboratorio Analisi Chimico Cliniche , Azienda Ospedaliera Luigi Sacco , Milan , Italy. 10. j Cardiology , Karolinska University Hospital , Stockholm , Sweden. 11. k Servizio Medicina di Laboratorio Azienda Ospedaliera , Universita di Padova Via Giustinianeo , Padova , Italy. 12. l Department of Acute Medicine , Cliniques Universitaires St-Luc Universite Catholiques de Louvain , Brussels , Belgium. 13. m Cardiology , Liverpool Hospital , Liverpool , NSW , Australia. 14. n Department of Pathology , University of Maryland , Baltimore , MD , USA. 15. o Department of Public Health Sciences , Henry Ford Hospital , Detroit , MI , USA. 16. p Department of Statistics , Roche Diagnostics , Penzberg , Germany. 17. q Uppsala Clinical Research Center , Uppsala University , Uppsala , Sweden.
Abstract
PURPOSE: To describe the baseline, 1 hr and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis. MATERIALS AND METHODS: hs-cTnT assay for RAPID rule out of acute myocardial infarction (TRAPID-AMI) was a prospective diagnostic trial that enrolled emergency department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin. The baseline, 1 hr and delta hs-cTnT values were analysed in the 902 non-ACS patients. RESULTS: Amongst the 1282 studied the patient groups were 213 (17%) AMI, 167 (13%) unstable angina, 113 (9%) non-ACS cardiac, 288 (22%) non-cardiac and 501 (39%) unknown origin. The hs-cTnT values in the non-cardiac and unknown origin groups were combined. The median hs-cTnT values (ng/L) were higher (p < 0.001) in the non-ACS cardiac compared to the non-cardiac/unknown origin group at baseline (11.8, <5) and 1 hr (12.3, <5). Their negative predictive values were 0.955 (baseline) and 0.954 (1 hr) for predicting non-ACS cardiac versus non-cardiac/unknown origin diagnoses. CONCLUSIONS: Hs-cTnT may help predict whether non-ACS ED patients have a final non-ACS cardiac or non-cardiac/unknown origin diagnoses.
PURPOSE: To describe the baseline, 1 hr and delta high sensitivity cardiac troponin (hs-cTnT) values in patients with suspected acute myocardial infarction (AMI) but without a final acute coronary syndrome (ACS) diagnosis. MATERIALS AND METHODS: hs-cTnT assay for RAPID rule out of acute myocardial infarction (TRAPID-AMI) was a prospective diagnostic trial that enrolled emergency department (ED) patients with suspected AMI. Final patient diagnoses were adjudicated by a clinical events committee and subjects placed in different clinical groups: AMI, unstable angina, non-ACS cardiac, non-cardiac and unknown origin. The baseline, 1 hr and delta hs-cTnT values were analysed in the 902 non-ACS patients. RESULTS: Amongst the 1282 studied the patient groups were 213 (17%) AMI, 167 (13%) unstable angina, 113 (9%) non-ACS cardiac, 288 (22%) non-cardiac and 501 (39%) unknown origin. The hs-cTnT values in the non-cardiac and unknown origin groups were combined. The median hs-cTnT values (ng/L) were higher (p < 0.001) in the non-ACS cardiac compared to the non-cardiac/unknown origin group at baseline (11.8, <5) and 1 hr (12.3, <5). Their negative predictive values were 0.955 (baseline) and 0.954 (1 hr) for predicting non-ACS cardiac versus non-cardiac/unknown origin diagnoses. CONCLUSIONS: Hs-cTnT may help predict whether non-ACS ED patients have a final non-ACS cardiac or non-cardiac/unknown origin diagnoses.
Entities:
Keywords:
High sensitivity troponin; emergency department; non ACS patients
Authors: Nivethitha Ilangkovan; Hans Mickley; Axel Diederichsen; Annmarie Lassen; Thomas L Sørensen; Hussam Mahmoud Sheta; Peter B Stæhr; Christian Backer Mogensen Journal: BMJ Open Date: 2017-12-22 Impact factor: 2.692