Algorithms incorporating glucose with cardiac troponin yielded sensitivity ≥99%, NPV ≥99.5%, specificity ≥99%, and PPV ≥80% for early rule-in and rule-out of myocardial infarction.
Observational (n=1,137)
Do algorithms incorporating glucose with cardiac troponin improve the early rule-in and rule-out of myocardial infarction in patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome?
Algorithms incorporating glucose with cardiac troponin may lead to an earlier and highly accurate rule-in and rule-out of myocardial infarction in patients with suspected ACS.
Abstract BACKGROUND Early rule-in/rule-out of myocardial infarction (MI) in patients presenting to the emergency department (ED) is important for patient care and resource allocation. Given that dysglycemia is a strong risk factor for MI, we sought to explore and compare different combinations of cardiac troponin (cTn) cutoffs with glycemic markers for the early rule-in/rule-out of MI. METHODS We included ED patients (n = 1137) with symptoms suggestive of acute coronary syndrome (ACS) who had cTnI, high-sensitivity cTnI (hs-cTnI), hs-cTnT, glucose, and hemoglobin A1c (Hb A1c) measurements. We derived rule-in/rule-out algorithms using different combinations of ROC-derived and literature cutoffs for rule-in and rule-out of MI within 7 days after presentation. These algorithms were then tested for MI/cardiovascular death and ACS/cardiovascular death at 7 days. ROC curves, sensitivity, specificity, likelihood ratios, positive and negative predictive values (PPV and NPV), and CIs were determined for various biomarker combinations. RESULTS MI was diagnosed in 133 patients (11.7%; 95% CI, 9.8–13.8). The algorithms that included cTn and glucose produced the greatest number of patients ruled out/ruled in for MI and yielded sensitivity ≥99%, NPV ≥99.5%, specificity ≥99%, and PPV ≥80%. This diagnostic performance was maintained for MI/cardiovascular death but not for ACS/cardiovascular death. The addition of hemoglobin A1c (Hb A1c) (≥6.5%) to these algorithms did not change these estimates; however, 50 patients with previously unknown diabetes may have been identified if Hb A1c was measured. CONCLUSIONS Algorithms incorporating glucose with cTn may lead to an earlier MI diagnosis and rule-out for MI/cardiovascular death. Addition of Hb A1c into these algorithms allows for identification of diabetes. Future studies extending these findings are needed for ACS/cardiovascular death. ClinicalTrials.gov identifier: NCT01994577
Shortt et al. (Fri,) conducted a observational in Symptoms suggestive of acute coronary syndrome (n=1,137). Algorithms combining cardiac troponin and glucose was evaluated on Rule-in and rule-out of myocardial infarction within 7 days after presentation. Algorithms incorporating glucose with cardiac troponin yielded sensitivity ≥99%, NPV ≥99.5%, specificity ≥99%, and PPV ≥80% for early rule-in and rule-out of myocardial infarction.