Details

Autor(en) / Beteiligte

• Rubini Giménez, Maria
• Hoeller, Rebeca
• Reichlin, Tobias
• Zellweger, Christa
• Twerenbold, Raphael
• Reiter, Miriam
• Moehring, Berit
• Wildi, Karin
• Mosimann, Tamina
• Mueller, Mira
• Meller, Bernadette
• Hochgruber, Thomas
• Ziller, Ronny
• Sou, Seoung Mann
• Murray, Karsten
• Sakarikos, Konstantin
• Ernst, Susanne
• Gea, Joaquim
• Campodarve, Isabel
• Vilaplana, Carles
• Haaf, Philip
• Steuer, Stephan
• Minners, Jan
• Osswald, Stefan
• Mueller, Christian

Titel

Rapid rule out of acute myocardial infarction using undetectable levels of high-sensitivity cardiac troponin

Ist Teil von

• International journal of cardiology, 2013-10, Vol.168 (4), p.3896-3901

Ort / Verlag

Shannon: Elsevier Ireland Ltd

Erscheinungsjahr

2013

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background We examined whether undetectable levels of high-sensitivity cardiac Troponin (hs-cTn) can be used to rule out acute myocardial infarction (AMI) with a single blood draw at presentation to the emergency department (ED). Methods and results In a prospective multicenter study we used 4 different hs-cTn assays (hs-cTnT Roche, and hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting with acute chest pain. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available data including serial hs-cTnT levels. Mean follow up was 24 months. Among 2072 consecutive patients with available hs-cTnT levels, 21% had an adjudicated diagnosis of AMI. Among AMI patients, 98.2% had initially detectable levels of hs-cTnT (sensitivity 98.2%, 95%CI 96.3%–99.2%, negative predictive value (NPV) 98.6%, 95%CI 97.0%–99.3%). Undetectable levels of hs-cTnT ruled out AMI in 26.5% of patients at presentation. The NPV was similar with the three hs-cTnI assays: among 1180 consecutive patients with available hs-cTnI (Siemens), the NPV was 98.8%; among 1151 consecutive patients with available hs-cTnI (Beckman Coulter), the NPV was 99.2%; among 1567 consecutive patients with available hs-cTnI (Abbott), the NPV was 100.0%. The percentage of patients with undetectable levels of hs-cTnI was similar among the three hs-cTnI assays and ranged from 11.4% to 13.9%. Conclusions Undetectable levels of hs-cTn at presentation have a very high NPV and seem to allow the simple and rapid rule out of AMI. This criteria applies to much more patients with hs-TnT as compared to the investigated hs-cTnI assays.