Faculty Opinions recommendation of One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I.

Author(s):  
Patrick Ray
Circulation ◽  
2017 ◽  
Vol 135 (17) ◽  
pp. 1597-1611 ◽  
Author(s):  
Jasper Boeddinghaus ◽  
Thomas Nestelberger ◽  
Raphael Twerenbold ◽  
Karin Wildi ◽  
Patrick Badertscher ◽  
...  

2016 ◽  
Vol 171 (1) ◽  
pp. 92-102.e5 ◽  
Author(s):  
Cedric Jaeger ◽  
Karin Wildi ◽  
Raphael Twerenbold ◽  
Tobias Reichlin ◽  
Maria Rubini Gimenez ◽  
...  

2018 ◽  
Vol 64 (5) ◽  
pp. 820-829 ◽  
Author(s):  
Jaimi Greenslade ◽  
Elizabeth Cho ◽  
Christopher Van Hise ◽  
Tracey Hawkins ◽  
William Parsonage ◽  
...  

Abstract BACKGROUND Low concentrations of cardiac troponin (cTn) have been recommended for rapid rule-out of acute myocardial infarction (AMI). We examined the Beckman Coulter Access high-sensitivity cardiac troponin I (hs-cTnI) assay to identify a single test threshold that can safely rule out AMI. METHODS This analysis used stored samples collected in 2 prospective observational studies. In all, 1871 patients presenting to a tertiary emergency department with symptoms of acute coronary syndrome had blood taken for measurement of cTnI on presentation. The endpoint was type 1 myocardial infarction (T1MI). Sensitivity and negative predictive value (NPV) were calculated for hs-cTnI values below the 99th percentile. RESULTS Ninety-eight patients had T1MI (5.2%), and 638 (34.1%) patients had an hs-cTnI <2 ng/L (limit of detection), with sensitivity of 99.0% (95% CI, 94.4%–100%) and NPV of 99.8% (95% CI, 99.1%–100%). No hs-cTnI value above a concentration of 2 ng/L achieved sensitivity of 99%. However, an NPV of 99.5% was achieved at values <6 ng/L. A cutoff <6 ng/L enabled 1475 (78.8%) patients to be ruled out on presentation with sensitivity of 93.9% (95% CI, 87.1%–97.7%). CONCLUSIONS A single baseline cTn <2 ng/L measured with the Access hs-cTnI assay performed well for rule-out of AMI. This cutoff concentration identified 99% of patients with AMI and could reduce the number of patients requiring lengthy assessment. A cutoff of <6 ng/L yielded a high NPV but missed more cases of AMI than would be acceptable to clinicians.


2015 ◽  
Vol 128 (8) ◽  
pp. 861-870.e4 ◽  
Author(s):  
Maria Rubini Gimenez ◽  
Raphael Twerenbold ◽  
Cedric Jaeger ◽  
Christian Schindler ◽  
Christian Puelacher ◽  
...  

2017 ◽  
Vol 130 (9) ◽  
pp. 1076-1083.e1 ◽  
Author(s):  
Yader Sandoval ◽  
Stephen W. Smith ◽  
Sara A. Love ◽  
Anne Sexter ◽  
Karen Schulz ◽  
...  

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