December 4, 1997New England Journal of Medicine
Emergency Room Triage of Patients with Acute Chest Pain by Means of Rapid Testing for Cardiac Troponin T or Troponin I
Why the study?
Does rapid bedside testing for cardiac troponin T and troponin I predict 30-day cardiac events in patients presenting to the emergency room with acute chest pain without ST-segment elevation?
Population
773 consecutive patients with acute chest pain for less than 12 hours without ST-segment elevation on their…
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Negative troponins identify low 30-day event risk in chest pain; supports validation in prospective trials before guiding discharge.
Key Points
- To assess the effectiveness of rapid testing for cardiac troponins in patients with acute chest pain in the emergency room.
- Prospective evaluation of 773 patients in emergency settings with acute chest pain for less than 12 hours.
- Bedside tests for troponin T and I were conducted upon arrival and again after four hours.
- Test results were provided to treating physicians for immediate clinical decisions.
- Troponin T positive in 16% of patients, and troponin I positive in 22%.
- Among patients with evolving myocardial infarction, troponin T was positive in 94% and troponin I in 100%.
- Negative test results showed a low event rate of 1.1% for troponin T and 0.3% for troponin I.
Structured PICO
Does rapid bedside testing for cardiac troponin T and troponin I predict 30-day cardiac events in patients presenting to the emergency room with acute chest pain without ST-segment elevation?
P
Population
773 consecutive patients with acute chest pain for less than 12 hours without ST-segment elevation on their electrocardiograms
I
Intervention
Rapid bedside testing for cardiac troponin T and troponin I (at least twice: on arrival and ≥4 hours later)
O
Outcome
Cardiac events (death and nonfatal myocardial infarction) at 30 dayshard clinical
Rapid bedside testing for cardiac troponins T and I is highly sensitive for early detection of myocardial injury and strongly predicts 30-day cardiac events, allowing safe discharge of patients with negative results.
Cite This Study
Hamm et al. (1997) studied this question.