November 22, 2011Emergency Medicine Journal
High-sensitivity troponin T for early rule-out of myocardial infarction in recent onset chest pain
Why the study?
Does high-sensitivity troponin T testing improve early detection and accelerated rule-in/rule-out of acute myocardial infarction in patients presenting with recent onset chest pain?
Population
n=385 patients presenting to the emergency department within 4 h of the onset of chest pain suggestive of…
Comparison
High-sensitivity troponin T testing at 0, 1, 2… vs Clinically applied troponin I
Design
Cohort
Follow-up
12-24 h
Authors
Discussion
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Implication
Supports 2-hour hsTnT plus ECG for early AMI rule-out; hypothesis-generating and requires prospective validation before practice change.
Key Points
- To determine whether high-sensitivity troponin T testing allows safe, accelerated rule-in and rule-out of acute myocardial infarction in emergency department patients with acute chest pain.
- Prospectively recruited 385 patients presenting to the emergency department within 4 hours of chest pain onset suggestive of acute coronary syndrome between November 2007 and April 2010.
- Measured blood levels and dynamic changes of high-sensitivity troponin T (hsTnT) and conventional troponin I at 0, 1, 2, and 12–24 hours post-presentation to evaluate diagnostic accuracy for acute myocardial infarction (AMI).
- Among 385 recruited patients, 82 (21.3%) had AMI; hsTnT at 2 hours demonstrated a sensitivity of 95.1% (95% CI, 88.7–98.1%), specificity of 75.6% (73.8–76.5%), and negative predictive value of 98.3% (96.0–99.3%).
- Incorporating electrocardiogram findings with 0- and 2-hour hsTnT measurements decreased the false-negative rate for AMI to 1.2%.
- Using a relative delta criterion of ≥20% between 0 and 2 hours increased diagnostic specificity to 92.4% (90.2–94.3%) but reduced sensitivity to 56.1% (48.0–63.2%).
Structured PICO
Does high-sensitivity troponin T testing improve early detection and accelerated rule-in/rule-out of acute myocardial infarction in patients presenting with recent onset chest pain?
P
Population
n=385 patients presenting to the emergency department within 4 h of the onset of chest pain suggestive of acute coronary syndrome
I
Intervention
High-sensitivity troponin T (hsTnT) testing at 0, 1, 2 and 12-24 h after presentation
C
Comparator
Clinically applied troponin I
O
Outcome
Admission diagnosis of acute myocardial infarction (AMI)
High-sensitivity troponin T measured at 0 and 2 hours, combined with ECG results, provides a high negative predictive value for the early rule-out of acute myocardial infarction.
Cite This Study
Aldous et al. (2011) studied this question.