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Algorithm for probable acute coronary syndrome using high-sensitivity troponin T assay vs fourth-generation troponin T assay.

AbstractBACKGROUND:
Chest pain represents between 5% and 10% of annual visits to emergency departments (EDs) and near 25% of hospitalizations. Characterization of chest pain is sometimes difficult, and strategies should focus on preventing inappropriate discharge of patients with acute coronary syndrome. The goal of our study is to compare negative predictive value of the algorithm in the chest pain unit using the fourth-generation troponin T assay (4GTT) vs high-sensitivity troponin T assay (HSTT).
METHODS:
We included 600 patients with probable acute coronary syndrome, who were discharged from the chest pain unit without an acute coronary syndrome: 300 patients in the 4GTT group and 300 patients in the HSTT group. Clinical and laboratory variables were analyzed. All the patients were followed up at 30 days, and the cardiovascular events were recorded.
RESULTS:
Major cardiac events occurred in only 3 (1.2%) in the HSTT group vs 5 (1.7%) in the 4GTT group (P, nonsignificant). The negative predictive value was 99% in both groups. Emergency department length of stay was 4.3 ± 2.6 hours in HSTT group vs 10 ± 3.4 hours in the 4GTT group (P = .01).
CONCLUSION:
The algorithm in the chest pain unit using HSTT showed to have the same negative predictive value as the algorithm with the 4GTT but with a shorter stay in the ED.
AuthorsDiego Conde, Juan Pablo Costabel, Florencia Lambardi
JournalThe American journal of emergency medicine (Am J Emerg Med) Vol. 31 Issue 8 Pg. 1226-9 (Aug 2013) ISSN: 1532-8171 [Electronic] United States
PMID23810070 (Publication Type: Journal Article)
CopyrightCopyright © 2013 Elsevier Inc. All rights reserved.
Chemical References
  • Troponin T
Topics
  • Acute Coronary Syndrome (blood, complications, diagnosis)
  • Aged
  • Algorithms
  • Angina, Unstable (blood, diagnosis)
  • Chest Pain (diagnosis, etiology)
  • Decision Support Techniques
  • Emergency Service, Hospital
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction (blood, diagnosis)
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Time Factors
  • Troponin T (blood)

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