Delta troponin for the early diagnosis of AMI in emergency patients with chest pain

Cullen, L., Parsonage, W.A., Greenslade, J., Lamanna, A., Hammett, C.J., Than, M., Tate, J., Kalinowski, L., Ungerer, J.P.J., Chu, K. and Brown, A. (2013) Delta troponin for the early diagnosis of AMI in emergency patients with chest pain. International Journal of Cardiology, 168 3: 2602-2608. doi:10.1016/j.ijcard.2013.03.044

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Author Cullen, L.
Parsonage, W.A.
Greenslade, J.
Lamanna, A.
Hammett, C.J.
Than, M.
Tate, J.
Kalinowski, L.
Ungerer, J.P.J.
Chu, K.
Brown, A.
Title Delta troponin for the early diagnosis of AMI in emergency patients with chest pain
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 0167-5273
Publication date 2013-10-03
Sub-type Article (original research)
DOI 10.1016/j.ijcard.2013.03.044
Open Access Status
Volume 168
Issue 3
Start page 2602
End page 2608
Total pages 7
Place of publication Shannon, Co. Clare Ireland
Publisher Elsevier Ireland Ltd
Language eng
Subject 2705 Cardiology and Cardiovascular Medicine
Abstract Objectives In patients presenting to the Emergency Department (ED) with potential acute myocardial infarction (AMI), elevated cardiac troponin (cTn) levels are indicative of myocardial necrosis. We assessed the accuracy of 'delta cTn' at 2 h or 6 h compared to the cTn concentration above the 99th percentile reference value for AMI in a prospective study of adult patients presenting to ED with symptoms suggestive of possible acute coronary syndrome. Methods Blood was sampled for cardiac troponin I (cTnI) on presentation, and at 2 h and 6 h following presentation using a sensitive assay (Beckman AccuTnI). All clinical endpoints were adjudicated by a cardiologist who was blinded to the 2 h cTn assay result. Results Of the 874 patients, 70 (8%) were diagnosed with an AMI during their index presentation. The area under the ROC curve for diagnosing AMI at 2 h was 0.89 [95%CI, 0.84-0.95] for absolute delta cTn versus 0.79 [95%CI 0.73-0.85] for the relative change. Specificity and PPV at 2 h were optimized using a delta cTnI ≥ 0.03 μg/L (95.8% [95%CI 94.1-97.0] and 61.4% [95%CI 50.9-70.9] respectively). Sensitivity and NPV for AMI were optimized using the 99th percentile with the addition of a delta of < 0.03 μg/L (97.1% [95%CI 90.2-99.2] and 99.7% [95%CI 99-99.9] respectively). Conclusions An algorithm incorporating cTnI concentration and delta cTn values with a sensitive troponin assay allows accurate diagnosis of AMI within 2 h from presentation and earlier rule-out of AMI in the majority of patients.
Keyword Acute coronary syndrome
Chest pain
Emergency medicine
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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