Rapid rule out of acute myocardial infarction using undetectable levels of high-sensitivity cardiac troponin

被引：157

作者：

Gimenez, Maria Rubini ^{[1
]}

Hoeller, Rebeca ^{[1
]}

Reichlin, Tobias ^{[1
,2
]}

Zellweger, Christa ^{[1
]}

Twerenbold, Raphael ^{[1
,2
]}

Reiter, Miriam ^{[1
]}

Moehring, Berit ^{[1
]}

Wildi, Karin ^{[1
]}

Mosimann, Tamina ^{[1
]}

Mueller, Mira ^{[1
]}

Meller, Bernadette ^{[1
]}

Hochgruber, Thomas ^{[1
]}

Ziller, Ronny ^{[1
]}

Sou, Seoung Mann ^{[1
]}

Murray, Karsten ^{[1
]}

Sakarikos, Konstantin ^{[1
]}

Ernst, Susanne

Gea, Joaquim ^{[3
]}

Campodarve, Isabel ^{[4
]}

Vilaplana, Carles ^{[5
]}

Haaf, Philip ^{[1
,2
]}

Steuer, Stephan ^{[6
,7
]}

Minners, Jan ^{[1
]}

Osswald, Stefan ^{[1
]}

Mueller, Christian ^{[1
]}

机构：

[1] Univ Basel Hosp, Dept Cardiol, CH-4031 Basel, Switzerland

[2] Univ Basel Hosp, Dept Internal Med, CH-4031 Basel, Switzerland

[3] Parc Salut Mar IMIM UPF CIBERES ISC Iii, Dept Pneumol, Barcelona, Spain

[4] Parc Salut Mar, Emergency Dept, Barcelona, Spain

[5] Parc Salut Mar, Lab Serv, Barcelona, Spain

[6] Brigham & Womens Hosp, Dept Med, Div Cardiovasc, Boston, MA 02115 USA

[7] Harvard Univ, Sch Med, Boston, MA USA

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2013年 / 168卷 / 04期

基金：

瑞士国家科学基金会;

关键词：

Acute myocardial infarction; High sensitive cardiac troponin; Rapid rule-out; EARLY-DIAGNOSIS; INCREMENTAL VALUE; ASSAY; RISK; GUIDELINES; VALUES;

D O I：

10.1016/j.ijcard.2013.06.049

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: We examined whether undetectable levels of high-sensitivity cardiac Troponin (hs-cTn) can be used to rule out acute myocardial infarction (AMI) with a single blood draw at presentation to the emergency department (ED). Methods and results: In a prospective multicenter study we used 4 different hs-cTn assays (hs-cTnT Roche, and hs-cTnI Siemens, hs-cTnI Beckman Coulter and hs-cTnI Abbott) in consecutive patients presenting with acute chest pain. The final diagnosis of AMI was adjudicated by two independent cardiologists using all available data including serial hs-cTnT levels. Mean follow up was 24 months. Among 2072 consecutive patients with available hs-cTnT levels, 21% had an adjudicated diagnosis of AMI. Among AMI patients, 98.2% had initially detectable levels of hs-cTnT (sensitivity 98.2%, 95%CI 96.3%-99.2%, negative predictive value (NPV) 98.6%, 95%CI 97.0%-99.3%). Undetectable levels of hs-cTnT ruled out AMI in 26.5% of patients at presentation. The NPV was similar with the three hs-cTnI assays: among 1180 consecutive patients with available hs-cTnI (Siemens), the NPV was 98.8%; among 1151 consecutive patients with available hs-cTnI (Beckman Coulter), the NPV was 99.2%; among 1567 consecutive patients with available hs-cTnI (Abbott), the NPV was 100.0%. The percentage of patients with undetectable levels of hs-cTnI was similar among the three hs-cTnI assays and ranged from 11.4% to 13.9%. Conclusions: Undetectable levels of hs-cTn at presentation have a very high NPV and seem to allow the simple and rapid rule out of AMI. This criteria applies to much more patients with hs-TnT as compared to the investigated hs-cTnI assays. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

引用

页码：3896 / 3901

页数：6

共 25 条

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