Michael E. Farkouh, MD, MSc; Peter Munk Cardiac Centre
In adults presenting to the emergency department (ED) with chest pain, is high-sensitivity troponin (hs-cTnT) with a low cutpoint (3 ng/L) accurate for detecting acute myocardial infarction (AMI)?
Blinded comparison of hs-cTnT with final clinical diagnosis.
Manchester Royal Infirmary ED in Manchester, England.
703 adults > 25 years of age (mean age 59 y, 61% men) who presented to the ED within 24 hours of onset of chest pain suggestive of a cardiac nature. Exclusion criteria included renal failure requiring dialysis, trauma with suspected myocardial contusion, and other medical conditions requiring hospital admission.
hs-cTnT assay (Roche Diagnostics, Basel, Switzerland), with cutpoints of 3 ng/L and 14 ng/L (99th percentile).
Final clinical diagnosis by 2 independent cardiologists using all clinical, laboratory, and imaging data available except the study test.
Sensitivity, specificity, and positive and negative likelihood ratios for diagnosis of AMI.
The median time from symptom onset to venipuncture was 3.5 hours. 19% of patients were diagnosed with AMI; no patient with AMI had an hs-cTnT level < 3 ng/L at presentation. The diagnostic characteristics of the hs-cTnT assay are shown in the Table.
In adults presenting to the emergency department with chest pain, high-sensitivity troponin testing results < 3 ng/L ruled out acute myocardial infarction.
*Diagnostic terms defined in Glossary. LRs calculated from data in article.
Farkouh ME, Cardiac Centre PM. High-sensitivity troponin < 3 ng/L ruled out acute myocardial infarction. Ann Intern Med. ;156:JC2–9. doi: 10.7326/0003-4819-156-4-201202210-02009
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Published: Ann Intern Med. 2012;156(4):JC2-9.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine.
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