Diagnostic value of high sensitive troponin T in chest pain patients with no persistent ST-elevations

ObjectiveCeramides are associated with coronary plaque vulnerability. We aim to investigate the potential diagnostic value of ceramides for acute coronary syndrome (ACS) in Chinese patients with chest pain.DesignProspective observational survey.SettingShanghai, China, 2016–2017.ParticipantsA total of 2773 patients with chest pain from four hospitals in Shanghai, China, between August 2016 and October 2017.Main outcome measuresPerformance of metabolites model in detection of ACS cases including ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina.ResultsPlasma levels of 12 ceramide molecules and corresponding ratios were compared between patients diagnosed with ACS and those without. Cer(d18:1/24:1(15Z))/Cer(d18:1/24:0) ratio, Cer(d18:1/14:0) and Cer(d18:1/22:0) were independent predictors of ACS after adjustment of traditional risk factors and high-sensitivecardiac troponin T. Receiver operating characteristic curve analysis showed a significant improvement in detecting ACS in the multivariable model with ceramides compared with that without (0.865 (0.840 to 0.889) vs 0.808 (0.776 to 0.841), p<0.001).ConclusionDistinct plasma ceramides are independent diagnostic predictors of ACS among patients with chest pain. Ceramides together with high-sensitive troponin and traditional factors showed great potential in identifying ACS among patients with chest pain.

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HIGH SENSITIVE TROPONIN T RULES OUT MYOCARDIAL INFARCTION 2 HOURS FROM ADMISSION IN CHEST PAIN PATIENTS.

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(10)61108-4 ◽

2010 ◽

Vol 55 (10) ◽

pp. A118.E1107 ◽

Cited By ~ 1

Author(s):

Dina Melki ◽

Suzanne Lind ◽

Stefan Agewall ◽

Tomas Jernberg

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Troponin T ◽

Pain Patients ◽

High Sensitive Troponin

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EXCELLENT EARLY RISK STRATIFICATION USING TROPONINS AND N-TERMNIAL PRO-BRAIN NATRIURETIC PEPTIDES IN CHEST PAIN PATIENTS BUT NO ADDITIONAL VALUE OF HIGH-SENSITIVE TROPONIN T

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)61080-2 ◽

2011 ◽

Vol 57 (14) ◽

pp. E1080 ◽

Cited By ~ 1

Author(s):

Dina Melki ◽

Suzanne Lind ◽

Stefan Agewall ◽

Tomas Jernberg

Keyword(s):

Chest Pain ◽

Risk Stratification ◽

Natriuretic Peptides ◽

Troponin T ◽

Early Risk ◽

Brain Natriuretic Peptides ◽

Additional Value ◽

Pain Patients ◽

High Sensitive Troponin

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Faculty Opinions recommendation of High-sensitivity troponin T concentrations in acute chest pain patients evaluated with cardiac computed tomography.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.2811956.2477054 ◽

2010 ◽

Author(s):

Christopher de Filippi ◽

Puneet Gandotra

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Troponin T ◽

Cardiac Computed Tomography ◽

Acute Chest Pain ◽

High Sensitivity ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T ◽

Pain Patients

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Effectiveness and Safety of the European Society of Cardiology 0-/1-h Troponin Rule-Out Protocol: The Design of the ESC-TROP Multicenter Implementation Study

Cardiology ◽

10.1159/000509390 ◽

2020 ◽

Vol 145 (11) ◽

pp. 685-692

Author(s):

Arash Mokhtari ◽

Ardavan Khoshnood ◽

Jakob Lundager Forberg ◽

Caroline Hård af Segerstad ◽

Ulf Ekström ◽

...

Keyword(s):

Chest Pain ◽

Clinical Assessment ◽

European Society ◽

Troponin T ◽

High Sensitivity ◽

Routine Care ◽

Coronary Syndrome ◽

European Society Of Cardiology ◽

Pain Patients ◽

Rule Out

Chest pain is one of the most common complaints at the emergency department (ED), and it is commonly the perceived likelihood of acute coronary syndrome (ACS) that drives management. Guidelines from the European Society of Cardiology (ESC) recommend the use of a 0-/1-h high-sensitivity cardiac troponin T (hs-cTnT) protocol to rule out or in ACS, but this is mostly based on observational studies. The aim of the ESC-TROP trial is to determine the safety and effectiveness of the ESC 0-/1-h hs-cTnT protocol when implemented in routine care. Adult chest pain patients at 5 EDs in the Skåne Region, Sweden, are included in the trial. The 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and electrocardiography (ECG) is implemented at 3 EDs, and the other 2 EDs act as concurrent controls. Outcomes will be evaluated during the 10 months after the implementation and the corresponding 10 months of the previous year. The 2 co-primary outcomes are (a) acute myocardial infarction (AMI) and all-cause death within 30 days in patients discharged from the ED, and (b) ED length of stay of the same patients. Secondary outcomes include the proportion of chest pain patients discharged from the ED and the number of ruled-out patients undergoing objective testing within 30 days. The ESC-TROP trial will determine the performance and applicability of the 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and ECG when implemented in routine ED care. It will provide evidence whether 0-/1-h hs-cTnT testing is safe, effective, and feasible, and whether widespread implementation as recommended by ESC guidelines should be supported.

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LO97: Validation of the HEART score in Canadian emergency department chest pain patients using a high-sensitivity troponin T assay

CJEM ◽

10.1017/cem.2017.159 ◽

2017 ◽

Vol 19 (S1) ◽

pp. S61-S62 ◽

Cited By ~ 1

Author(s):

J. Andruchow ◽

A. McRae ◽

T. Abedin ◽

D. Wang ◽

G. Innes ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Troponin T ◽

High Sensitivity ◽

Low Risk ◽

Moderate Risk ◽

Heart Score ◽

High Sensitivity Troponin ◽

High Sensitivity Troponin T ◽

Pain Patients

Introduction: The HEART score is a validated tool created to risk stratify emergency department (ED) chest pain patients using 5 simple criteria (History, ECG findings, Age, Risk factors, and Troponin). Several studies have demonstrated the superiority of HEART over other well known risk stratification tools in identifying low risk chest pain patients suitable for early discharge. All but one of these studies used conventional troponin assays, and most were conducted in European populations. This study aims to validate the HEART score using a high-sensitivity troponin T assay in a Canadian population. Methods: This prospective cohort study was conducted at a single urban tertiary centre and regional percutaneous coronary intervention site in Calgary, Alberta. Patients were eligible for enrolment if they presented to the ED with chest pain, were age 25-years or older and required biomarker testing to rule out AMI at the discretion of the attending emergency physician. Patients were excluded if they had clear acute ischemic ECG changes, new arrhythmia or renal failure requiring hemodialysis. Clinical data were recorded by the emergency physician at the time of enrolment and outcomes were obtained from administrative data. High-sensitivity troponin-T (Roche Elecsys hs-cTnT) results were obtained in all patients at presentation. The primary outcome was AMI within 30-days of ED visit, the secondary outcome was 30-day major adverse cardiac events (MACE). Results: A total of 984 ED patients with complete HEART scores were enrolled from August 2014 to September 2016. The 30-day incidence of AMI and MACE in the overall population was 3.3% and 20.6%, respectively. HEART scores were predictive of 30-day AMI incidence: low risk (0-3): 0.77% (95%CI 0.0-1.5%), moderate risk (4-6): 4.3% (95%CI 2.3-6.2%) and high risk (7-10): 12.2% (95%CI 5.5-19.0%). HEART scores also predicted 30-day MACE: low risk (0-3): 5.0% (95%CI 3.1-6.9%), moderate risk (4-6): 31.8% (95%CI 27.2-36.4%) and high-risk (7-10): 61.4% (95%CI 51.2-71.5%). More than half of patients, 522 (53.0%) could be identified as low risk based on the HEART score using a single troponin result. Conclusion: Using a single high-sensitivity troponin result collected at ED presentation, the HEART score can rapidly and effectively identify more than half of ED chest pain patients as low risk for 30-day AMI, but is less sensitive for 30-day MACE.

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Predictive Value of a 6-Hour Ecg/Troponin Protocol in Patients with Chest Pain

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790301000303 ◽

2003 ◽

Vol 10 (3) ◽

pp. 146-152 ◽

Cited By ~ 1

Author(s):

CY Man ◽

PA Cameron ◽

WL Cheung

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Troponin T ◽

Low Risk ◽

Chinese Patients ◽

Initial Assessment ◽

Coronary Syndrome ◽

Pain Patients

Introduction Patients presenting with chest pain and considered to be at low risk of acute coronary syndrome (ACS) may still have coronary heart disease. The potential risk of sudden cardiac death due to arrhythmias or progression to acute myocardial infarction still exists. To minimize this risk, we have designed a 6-hour risk stratification protocol for patients with a low risk of acute myocardial infarction on initial assessment in the Accident and Emergency Department (AED). Materials & Methods This was a retrospective observational study with the aim of determining the risk of adverse cardiovascular events in chest pain patients attending an AED. These patients were subject to an ECG and cardiac troponin T tests (cTnT) at 0 hour and at 6 hours (if the two tests were negative at 0 hour), and were put under observation in the AED observation ward during the same period. The main outcome measures were adverse cardiac events at 30 days. Results A total of 371 Chinese patients considered to have low risk of ACS were recruited into the protocol. Troponin T tested positive in 19 patients (5.1%) at 0 hour and 8 patients (2.2%) at 6 hours. Amongst the 332 patients that were discharged directly from the AED, there were no re-admissions for cardiac-related deaths, acute myocardial infarction, arrhythmia or heart failure. Conclusion The 6-hour ECG and troponin T observation protocol is a useful tool to allow safe discharge of chest pain patients who are at low risk of acute coronary syndrome.

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