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The Use of Very Low Concentrations of High-sensitivity Troponin T to Rule Out Acute Myocardial Infarction Using a Single Blood Test.

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Body, Richard Mueller, Christian Giannitsis, Evangelos Christ, Michael Ordonez-Llanos, Jorge Verschuren, Franck [UCL] TRAPID-AMI Investigators

(eng) BACKGROUND: Recent single-center and retrospective studies suggest that acute myocardial infarction (AMI) could be immediately excluded without serial sampling in patients with initial high-sensitivity cardiac troponin T (hs-cTnT) levels below the limit of detection (LoD) of the assay and no electrocardiogram (ECG) ischemia. OBJECTIVE: We aimed to determine the external validity of those findings in a multicenter study at 12 sites in nine countries. METHODS: TRAPID-AMI was a prospective diagnostic cohort study including patients with suspected cardiac chest pain within 6 hours of peak symptoms. Blood drawn on arrival was centrally tested for hs-cTnT (Roche; 99th percentile = 14 ng/L, LoD = 5 ng/L). All patients underwent serial troponin sampling over 4-14 hours. The primary outcome, prevalent AMI, was adjudicated based on sensitive troponin I (Siemens Ultra) levels. Major adverse cardiac events (MACE) including AMI, death, or rehospitalization for acute coronary syndrome with coronary revascularization were determined after 30 days. RESULTS: We included 1,282 patients, of whom 213 (16.6%) had AMI and 231 (18.0%) developed MACE. Of 560 (43.7%) patients with initial hs-cTnT levels below the LoD, four (0.7%) had AMI. In total, 471 (36.7%) patients had both initial hs-cTnT levels below the LoD and no ECG ischemia. These patients had a 0.4% (n = 2) probability of AMI, giving 99.1% (95% confidence interval [CI] = 96.7% to 99.9%) sensitivity and 99.6% (95% CI = 98.5% to 100.0%) negative predictive value. The incidence of MACE in this group was 1.3% (95% CI = 0.5% to 2.8%). CONCLUSIONS: In the absence of ECG ischemia, the detection of very low concentrations of hs-cTnT at admission seems to allow rapid, safe exclusion of AMI in one-third of patients without serial sampling. This could be used alongside careful clinical assessment to help reduce unnecessary hospital admissions.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2016
Language Anglais
Journal information "Academic Emergency Medicine" - Vol. 23, no. 9, p. 1004-1013 (2016)
Peer reviewed yes
Publisher Wiley-Blackwell Publishing, Inc. ((United States) Hoboken, NJ)
issn 1069-6563
e-issn 1553-2712
Publication status Publié
Affiliations UCL - SSS/IREC/MEDA - Pôle de médecine aiguë
UCL - (SLuc) Service des urgences
Links
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Bibliographic reference Body, Richard ; Mueller, Christian ; Giannitsis, Evangelos ; Christ, Michael ; Ordonez-Llanos, Jorge ; et. al. The Use of Very Low Concentrations of High-sensitivity Troponin T to Rule Out Acute Myocardial Infarction Using a Single Blood Test.. In: Academic Emergency Medicine, Vol. 23, no. 9, p. 1004-1013 (2016)
Permanent URL http://hdl.handle.net/2078.1/182466