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

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.

• Authors: Maria Rubini Giménez, Rebeca Hoeller, Tobias Reichlin, Christa Zellweger, Raphael Twerenbold, Miriam Reiter, Berit Moehring, Karin Wildi, Tamina Mosimann, Mira Mueller, Bernadette Meller, Thomas Hochgruber, Ronny Ziller, Seoung Mann Sou, Karsten Murray, Konstantin Sakarikos, Susanne Ernst, Joaquim Gea, Isabel Campodarve, Carles Vilaplana, Philip Haaf, Stephan Steuer, Jan Minners, Stefan Osswald, Christian Mueller
• Journal: International journal of cardiology (Int J Cardiol) Vol. 168 Issue 4 Pg. 3896-901 (Oct 09 2013) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 23876467 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2013.

Chemical References

• Biomarkers
• Troponin I
• Troponin T

Topics

• Aged
• Biomarkers (blood)
• Chest Pain (blood, diagnosis)
• Female
• Follow-Up Studies
• Humans
• Internationality
• Male
• Middle Aged
• Myocardial Infarction (blood, diagnosis)
• Predictive Value of Tests
• Prospective Studies
• Time Factors
• Troponin I (blood)
• Troponin T (blood)