Key result
Low peak cTnI, normal wall motion, and no prior CAD exclude ACS with 98% NPV.
Why the study?
Can simple clinical criteria (peak cTnI <2 ng/dL, absent wall-motion abnormality, no prior CAD history) reliably exclude ACS in hospitalized patients with elevated cTnI?
Observational (n=265)
Can simple clinical criteria (peak cTnI <2 ng/dL, absent wall-motion abnormality, no prior CAD history) reliably exclude ACS in hospitalized patients with elevated cTnI?
Effect estimate: OR 7.6 (95% CI 3.8-15.3)
A simple clinical model using peak cTnI <2 ng/dL, absent echocardiographic wall-motion abnormality, and no prior CAD history can reliably exclude ACS in hospitalized patients with elevated troponin.
May support ACS exclusion in troponin-positive inpatients; leaves open prospective validation before practice change.
BACKGROUND: Elevated cardiac troponin I (cTnI) occurs in acute coronary syndrome (ACS) as well as various scenarios not associated with ACS. HYPOTHESIS: Simple clinical criteria can reliably exclude ACS among hospitalized patients with elevated cTnI. METHODS: Records for patients hospitalized from January to April 2011 with elevated cTnI (>0.29 ng/dL) and an available echocardiogram were retrospectively reviewed. Patients with ST-segment elevation myocardial infarction were excluded. Based on available clinical data, patients were classified as having ACS or elevation of cTnI unrelated to ACS (non-ACS). Median follow-up was 365 days. RESULTS: Of 265 records meeting inclusion criteria, 82 (31%) had ACS and 183 (69%) had non-ACS. In multivariable analysis, odds ratios for non-ACS were 7.6 (95% confidence interval [CI]: 3.8-15.3) for peak cTnI <2 ng/dL, 6.3 (95% CI: 3.1-13.0) for absent wall-motion abnormality, and 4.4 (95% CI: 2.2-8.6) for no prior coronary artery disease history. The area under the receiver operating curve for amodel using these 3 variables was 0.86, with a 98% negative predictive value for excluding ACS. Patients who met these 3 criteria had no ACS-related deaths over 1-year follow-up. CONCLUSIONS: Hospitalized patients with peak Tn level<2 ng/dL, no prior history of coronary artery disease, and no new echocardiographic wall-motion abnormality appear to have a very low likelihood of ACS. Prospective validation of these results is needed to determine whether additional diagnostic testing could be safely avoided in hospitalized patients meeting these simple clinical criteria.
No takes yet. Share an insight, caveat, or question.
Davis et al. (2014) conducted an observational in Elevated cardiac troponin I (n=265). Clinical criteria (peak cTnI <2 ng/dL, absent wall-motion abnormality, no prior CAD) was evaluated on Non-ACS classification (OR 7.6, 95% CI 3.8-15.3). A clinical model using peak cTnI <2 ng/dL, absent wall-motion abnormality, and no prior coronary artery disease yielded an AUC of 0.86 and a 98% negative predictive value for excluding ACS.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: