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Serial Sampling of High-Sensitivity Cardiac Troponin T May Not Be Required for Prediction of Acute Myocardial Infarction Diagnosis in Chest Pain Patients with Highly Abnormal Concentrations at Presentation
- Source :
- CLINICAL CHEMISTRY, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname, Europe PubMed Central, Clinical Chemistry : international journal of molecular diagnostics and laboratory medicine, Vol. 63, no. 2, p. 542-551 (2017)
- Publication Year :
- 2017
- Publisher :
- AMER ASSOC CLINICAL CHEMISTRY, 2017.
-
Abstract
- BACKGROUND Guidelines for diagnosing acute myocardial infarction (AMI) recommend adding kinetic changes to the initial cardiac troponin (cTn) blood concentration to improve AMI diagnosis. We hypothesized that kinetic changes may not be required in patients presenting with highly abnormal cTn. METHODS Patients presenting with suspected AMI to the emergency department were enrolled in a prospective diagnostic study. We assessed the positive predictive value (PPV) of initial high-sensitivity cardiac troponin T (hs-cTnT) blood concentrations alone and in combination with kinetic changes for AMI. Predefined relative changes (δ change of ≥20%) and absolute changes (Δ change ≥9.2 ng/L) within different time intervals (1 h, 2 h, and 4–14 h after presentation) were assessed. The final diagnosis was adjudicated by 2 independent cardiologists. RESULTS Among 1282 patients, 213 (16.6%) patients had a final diagnosis of AMI. For AMI prediction, PPVs increased from 48.8% for an initial hs-cTnT >14 ng/L to 87.2% for >60 ng/L, whereas PPVs remained unchanged for higher hs-cTnT concentrations at baseline (87.1% for both >80 ng/L and >100 ng/L). With addition of 20% relative Δ change, PPVs were not further improved in patients with baseline hs-cTnT >80 ng/L using the 1-h (84.0%) and 2-h (88.9%) intervals, and only minimally when extending the interval to 4–14 h (91.2% for >80 ng/L and 90.4% for >100 ng/L, respectively). Similar findings were observed when applying absolute changes. CONCLUSIONS In chest pain patients with highly abnormal hs-cTnT concentrations at presentation, subsequent blood draws may not be required, as they do not provide incremental diagnostic value for prediction of AMI diagnosis.
- Subjects :
- Male
medicine.medical_specialty
Chest Pain
Cardiac troponin
Clinical Biochemistry
Myocardial Infarction
030204 cardiovascular system & hematology
Chest pain
03 medical and health sciences
0302 clinical medicine
Troponin T
Predictive Value of Tests
Internal medicine
Medicine
Humans
030212 general & internal medicine
Myocardial infarction
Biochemistry (medical)
Aged
Aged, 80 and over
Serial sampling
business.industry
Emergency department
Middle Aged
medicine.disease
Surgery
Predictive value of tests
Acute Disease
Cardiology
Female
sense organs
Myocardial infarction diagnosis
medicine.symptom
business
Blood drawing
Subjects
Details
- ISSN :
- 00099147
- Database :
- OpenAIRE
- Journal :
- CLINICAL CHEMISTRY, r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau, instname, Europe PubMed Central, Clinical Chemistry : international journal of molecular diagnostics and laboratory medicine, Vol. 63, no. 2, p. 542-551 (2017)
- Accession number :
- edsair.doi.dedup.....c73e0e68e7cecdf9c3864b887a596863