Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction.

Link to article at PubMed

Related Articles

Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction.

J Am Coll Cardiol. 2014 Mar 25;

Authors: Bandstein N, Ljung R, Johansson M, Holzmann MJ

Abstract
OBJECTIVES: To evaluate if an undetectable (< 5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level, and an electrocardiogram (ECG) without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).
BACKGROUND: Chest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Since there is no rapid way to rule out MI many patients are admitted to hospital.
METHODS: All patients who sought medical attention for chest pain, and had at least one hs-cTnT analyzed, during two years at the Karolinska university hospital, Stockholm, Sweden were included. We calculated the negative predictive values of an undetectable hs-cTnT, and ECG without ischemia, for MI and death within 30 days.
RESULTS: We included 14,636 patients of whom 8,907 (61%) had an intial hs-cTnT of < 5 ng/l, 21% had 5 to 14 ng/l, and 18% had > 14 ng/l. During 30 days of follow-up 39 (0.44%) patients with undetectable hs-cTnT had a MI, of whom 15 (0.17%) had no ischemic ECG changes. The negative predictive value for MI within 30 days in patients with undetectable hs-cTnT, and no ischemic ECG changes was 99.8% (95% confidence interval (CI) 99.7-99.9). The negative predictive value for death was 100% (95% CI 99.9-100).
CONCLUSIONS: All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on ECG have a minimal risk of MI or death within 30 days and can be safely discharged directly from the ED.

PMID: 24694529 [PubMed - as supplied by publisher]

Leave a Reply

Your email address will not be published. Required fields are marked *