Performance of Risk Stratification for Acute Coronary Syndrome with Two-hour Sensitive Troponin Assay Results

Cullen, L., Greenslade, J., Than, M., Tate, J., Ungerer, J.P.J., Pretorius, C., Hammett, C.J., Lamanna, A., Chu, K., Brown, A.F.T. and Parsonage, W.A. (2014) Performance of Risk Stratification for Acute Coronary Syndrome with Two-hour Sensitive Troponin Assay Results. Heart Lung and Circulation, 23 5: 428-434. doi:10.1016/j.hlc.2013.11.003

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Author Cullen, L.
Greenslade, J.
Than, M.
Tate, J.
Ungerer, J.P.J.
Pretorius, C.
Hammett, C.J.
Lamanna, A.
Chu, K.
Brown, A.F.T.
Parsonage, W.A.
Title Performance of Risk Stratification for Acute Coronary Syndrome with Two-hour Sensitive Troponin Assay Results
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
Publication date 2014-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.hlc.2013.11.003
Open Access Status Not yet assessed
Volume 23
Issue 5
Start page 428
End page 434
Total pages 7
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Language eng
Subject 2740 Pulmonary and Respiratory Medicine
2705 Cardiology and Cardiovascular Medicine
Abstract Background: Risk stratification processes for patients with possible acute coronary syndrome (ACS) recommend the use of serial sensitive troponin testing over at least 6. h. Troponin assays vary in their analytical performance. Utility in accurate risk stratification at 2. h post-presentation is unknown. Methods: A diagnostic accuracy study of patients presenting to the emergency department (ED) with symptoms of ACS was performed. Troponin was measured at 0, 2 and 6. h post-presentation. Acute myocardial infarction (AMI) was adjudicated by cardiologists and incorporated the 0 and 6. h troponin values measured by a sensitive troponin assay. Results were described using standard measures of test accuracy. Results: Of the 685 patients, 51 (7.4%) had 30-day AMI or cardiac death, and 76 (11.1%) had secondary outcomes (all cause death, ACS and revascularisation procedures). There was no significant difference in the diagnostic accuracy of early versus late biomarker strategies when used with the current risk stratification processes. Incorporation of a significant delta did not improve the stratification at 2. h post-presentation. Conclusions: Accelerated risk stratification of patients with ACS symptoms may occur at 2. h post-presentation using troponin results measured by a sensitive assay. Incorporation of such a strategy could support improvements in patient flow within EDs.
Keyword Acute coronary syndrome
Emergency Service
Risk stratification
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes published online 09 December 2013

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
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Created: Fri, 14 Mar 2014, 20:00:14 EST by Matthew Lamb on behalf of School of Medicine