scholarly journals An Algorithmic Approach Is Superior to the 99th Percentile Upper Reference Limits of High Sensitivity Troponin as a Threshold for Safe Discharge from the Emergency Department

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1083
Author(s):  
Taekyung Kang ◽  
Gwang Sil Kim ◽  
Young Sup Byun ◽  
Jongwoo Kim ◽  
Sollip Kim ◽  
...  
Keyword(s):  
Emergency Department ◽  
Predictive Value ◽  
Troponin I ◽  
High Sensitivity ◽  
Korean Population ◽  
Chest Discomfort ◽  
Single Measurement ◽  
Important Indicator ◽  
Algorithmic Approach ◽  
Reference Limits

Background and Objectives: High-sensitivity cardiac troponin I (hs-TnI) is an important indicator of acute myocardial infarction (AMI) among patients presenting with chest discomfort at the emergency department (ED). We aimed to determine a reliable hs-TnI cut-off by comparing various values for a baseline single measurement and an algorithmic approach. Materials and Methods: We retrospectively reviewed the hs-TnI values of patients who presented to our ED with chest discomfort between June 2019 and June 2020. We evaluated the diagnostic accuracy of AMI with the Beckman Coulter Access hs-TnI assay by comparing the 99th percentile upper reference limits (URLs) based on the manufacturer’s claims, the newly designated URLs in the Korean population, and an algorithmic approach. Results: A total of 1296 patients who underwent hs-TnI testing in the ED were reviewed and 155 (12.0%) were diagnosed with AMI. With a single measurement, a baseline hs-TnI cut-off of 18.4 ng/L showed the best performance for the whole population with a sensitivity of 78.7%, specificity of 95.7%, negative predictive value (NPV) of 97.1%, and positive predictive value (PPV) of 71.3%. An algorithm using baseline and 2–3 h hs-TnI values showed an 100% sensitivity, 97.7% specificity, an NPV of 100%, and a PPV of 90.1%. This algorithm used a cut-off of <4 ng/L for a single measurement 3 h after symptom onset or an initial level of <5 ng/L and a change of <5 ng/L to rule a patient out, and a cut-off of ≥50 ng/L for a single measurement or a change of ≥20 ng/L to rule a patient in. Conclusions: The algorithmic approach using serial measurements could help differentiate AMI patients from patients who could be safely discharged from the ED, ensuring that patients were triaged accurately and did not undergo unnecessary testing. The cut-off values from previous studies in different countries were effective in the Korean population.

scholarly journals Prospective validation of 0-hour/1-hour algorithm using high-sensitivity cardiac troponin I in Japanese patients presenting to emergency department

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Ohtake ◽  
J Ishii ◽  
H Nishimura ◽  
H Kawai ◽  
T Muramatsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Predictive Value ◽  
Cardiac Troponin ◽  
Troponin I ◽  
High Sensitivity ◽  
Japanese Patients ◽  
Cardiac Troponin I ◽  
St Segment Elevation ◽  
Rule Out

Abstract Background The diagnostic performance of 0-hour/1-hour algorithm using high-sensitivity cardiac troponin I (hsTnI) for non-ST-segment elevation myocardial infarction (NSTEMI) has not been evaluated in an Asian population. Purpose We aimed to prospectively validate the 0-hour/1-hour algorithm using hsTnI in a Japanese population. Method We enrolled 754 Japanese patients (mean age of 70 years, 395 men) presenting to our emergency department with symptoms suggestive of NSTEMI. The hsTnI concentration was measured using the Siemens ADVIA Centaur hsTnI assay at presentation and after 1 hour. Patients were divided into three groups according to the algorithm: hsTnI below 3 ng/L (only applicable if chest pain onset &gt;3 hours) or below 6 ng/L and delta 1 hour below 3 ng/L were the “rule-out” group; hsTnI at least 120 ng/L or delta 1 hour at least 12 ng/L were in the “rule-in” group; the remaining patients were classified as the “observe” group. Based on the Fourth Universal Definition of Myocardial Infarction, the final diagnosis was adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, and follow-up data. Safety of rule-out was quantified by the negative predictive value (NPV) for NSTEMI, accuracy of rule-in by the positive predictive value (PPV), and overall efficacy by the proportion of patients triaged towards rule-out or rule-in within 1 hour. Results Prevalence of NSTEMI was 6.5%. The safety of rule-out (NPV 100%), accuracy of rule-in (PPV 26%), and overall efficacy (54%) were shown in Figure. Conclusion The 0-hour/1-hour algorithm using hsTnI is very safe and effective in triaging Japanese patients with suspected NSTEMI. Funding Acknowledgement Type of funding source: None

scholarly journals Cardiac biomarkers as prognosticators among SARS-CoV-19 patients in a tertiary hospital in Philippines

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Ong ◽  
C Chacon ◽  
S Javier
Keyword(s):  
Creatine Kinase ◽  
Logistic Regression ◽  
Hospital Mortality ◽  
Roc Curve ◽  
Predictive Value ◽  
Troponin I ◽  
Binary Logistic Regression ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Optimal Cutoff

Abstract Background There is overwhelming volume of confirmed cases of COVID-19, despite this numerous knowledge gaps remain in the diagnosis, management, and prognostication of this novel coronavirus infection, making prevention and control a challenge. Methods This retrospective cohort study included patients with real-time reverse transcriptase polymerase chain reaction (rRT-PCR)-confirmed COVID-19. Binary logistic regression was used to determine the association between the cardiac biomarkers and in-hospital mortality. ROC, AUC, and cutoff analyses were used to determine optimal cutoff values for the cardiac biomarkers. Results A total of 90 subjects with a complete panel of cardiac biomarkers out of the 224 rRT-PCR confirmed cases were included. The median age was 57 years (IQR, 47–67 years), majority were males. Sixty-six (77.6%) subjects survived while 19 (22.4%) expired. The most common presenting symptom was fever (75.6%), and the most common comorbidity was hypertension (67.8%). Spearman rho correlation analysis showed moderate positive association of high sensitivity troponin I (hsTnI) with in-hospital mortality (R, 0.434, p = &lt;0.001). Multivariate binary logistic regression analysis showed that creatine kinase and hsTnI were independently associated with in-hospital mortality (OR, 4.103 [95% CI, 1.241–13.563], p=0.021; and OR, 7.899 [95% CI, 2.430–25.675], p=0.001, respectively). ROC curve analysis showed that hsTnI was a good predictor for in-hospital mortality (AUC, 0.829 [95% CI, 0.735–0.923], p = &lt;0.001) and that creatine kinase was a poor predictor (AUC, 0.677 [95% CI, 0.531–0.823], p=0.018). Optimal cutoff point derived from the ROC curve for hsTnI was 0.010 ng/ml (J, 0.574) with a sensitivity of 84% (TPR, 0.842 [95% CI, 0.604–0.966]), specificity of 73% (TNR, 0.732 [95% CI, 0.614–0.386]), and an adjusted negative predictive value of 99% (Known prevalence*adjusted NPV, 0.989), a positive likelihood ratio of 20% (LR+, 3.147 [95% CI, 2.044–4.844]) and a negative likelihood ratio of 30% (LR−, 0.216 [95% CI, 0.076–0.615]). Conclusion High sensitivity troponin I level was a good tool with a very high negative predictive value in significantly predicting in-hospital mortality among rRT-PCR positive COVID-19 patients. FUNDunding Acknowledgement Type of funding sources: None. ROC Curve

scholarly journals Myocardial Infarction Can Be Safely Excluded by High‐sensitivity Troponin I Testing 3 Hours After Emergency Department Presentation

2020 ◽  
Vol 27 (8) ◽  
pp. 671-680 ◽  
Author(s):  
W. Frank Peacock ◽  
Robert Christenson ◽  
Deborah B. Diercks ◽  
Christian Fromm ◽  
Gary F. Headden ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Troponin I ◽  
High Sensitivity ◽  
Emergency Department Presentation ◽  
High Sensitivity Troponin

scholarly journals Predictive value of high-sensitivity troponin I and D-dimer assays for adverse outcome in patients with acute pulmonary embolism

2012 ◽  
Vol 5 (2) ◽  
pp. 586-590 ◽  
Author(s):  
THOMAS WALTER ◽  
PAUL APFALTRER ◽  
FRANK WEILBACHER ◽  
MATHIAS MEYER ◽  
STEFAN O. SCHOENBERG ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Troponin I ◽  
Adverse Outcome ◽  
High Sensitivity ◽  
High Sensitivity Troponin ◽  
D Dimer
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