Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I

Johannes Tobias Neumann, Nils Arne Sörensen, Francisco Ojeda, Tjark Schwemer, Jonas Lehmacher, Saskia Gönner, Nikolas Jarsetz, Till Keller, Sarina Schaefer, Thomas Renné, Ulf Landmesser, Peter Clemmensen, Nataliya Makarova, Renate B. Schnabel, Tanja Zeller, Mahir Karakas, John W. Pickering, Martin Than, William Parsonage, Jaimi GreensladeLouise Cullen, Dirk Westermann, Stefan Blankenberg

Publikation: Bidrag til tidsskriftArtikelForskningpeer review

Abstrakt

AIMS: Serial measurements of high-sensitivity troponin are used to rule out acute myocardial infarction (AMI) with an assay specific cutoff at the 99th percentile. Here, we evaluated the performance of a single admission troponin with a lower cutoff combined with a low risk electrocardiogram (ECG) to rule out AMI. METHODS: Troponin I measured with a high-sensitivity assay (hs-TnI) was determined at admission in 1040 patients presenting with suspected AMI (BACC study). To rule out AMI we calculated the negative predictive value (NPV) utilizing the optimal hs-TnI cutoff combined with a low risk ECG. The results were validated in 3566 patients with suspected AMI [2-h Accelerated Diagnostic Protocol to Assess Patients With Chest Pain Symptoms Using Contemporary Troponins as the Only Biomarker (ADAPT) studies]. Patients were followed for 6 or 12 months. RESULTS: 184 of all patients were diagnosed with AMI. An hs-TnI cutoff of 3 ng/L resulted in a NPV of 99.3% (CI 97.3-100.0), ruling out 35% of all non-AMI patients. Adding the information of a low riskECGresulted in a 100% (CI 97.5-100.0) NPV (28% ruled out). The 2 validation cohorts replicated the high NPV of this approach. The follow-up mortality in the ruled out population was low (0 deaths in BACC and Stenocardia, 1 death in ADAPT). CONCLUSIONS: A single hs-TnI measurement on admission combined with a low risk ECG appears to rule out AMI safely without need for serial troponin testing. Trial Registration: www.clinicaltrials.gov (NCT02355457).

OriginalsprogEngelsk
Sider (fra-til)394-402
Antal sider9
TidsskriftClinical Chemistry
Vol/bind63
Udgave nummer1
DOI
StatusUdgivet - jan. 2017

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