Comparison Between Emergency Severity Index Plus Cardiac Troponin I Rapid Test and Emergency Severity Index in Patients Presenting with Low-Risk Chest Pain: A Randomized Clinical Trial

Background: There is difficulty in identifying low-risk patients with acute coronary syndrome in the emergency department (ED). Objectives: The aim of this study was to compare mistriage between the Emergency Severity Index (ESI) plus the cardiac troponin I rapid test (cTnI) and ESI among patients with chest pain. Methods: A randomized clinical trial was conducted from January to April 2019. One hundred patients with low-risk chest pain were randomly allocated to the ESI + cTnI and ESI groups. Triage levels, used resources, and mistriage rate were compared between both groups among patients discharged from the ED and admitted to the cardiac unit (CU) or coronary care unit (CCU). Results: Our samples included 100 patients (age: 52.9 ± 13.92 years; 51% female) who were equally assigned to the ESI + cTnI and ESI groups. Overtriage rate was 6% and 88% for the ESI + cTnI and ESI groups, respectively. The triage level between the ESI + cTnI and ESI groups was significantly different among patients who were discharged from the ED (3.92 vs. 3.00). Conclusions: The ESI + cTnI score seems to be more valid than the ESI scale to triage patients with low-risk chest pain. It is recommended to add cTnI to the ESI for the triage of patients with low-risk chest pain in the ED.

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DIAGNOSTIC AND PROGNOSTIC IMPLICATIONS OF UTILIZING A HIGH SENSITIVE CARDIAC TROPONIN I ASSAY FOR EVALUATION OF “LOW-RISK” CHEST PAIN PATIENTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)61017-6 ◽

2011 ◽

Vol 57 (14) ◽

pp. E1017

Author(s):

Christopher R. De Filippi ◽

Samantha Wood ◽

Puneet Gandotra ◽

MaryLou Gantzer ◽

Robert Gorman ◽

...

Keyword(s):

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Low Risk ◽

Prognostic Implications ◽

Pain Patients

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Analytical performance and clinical application of a new rapid bedside assay for the detection of serum cardiac troponin I

Clinical Chemistry ◽

10.1093/clinchem/44.9.1925 ◽

1998 ◽

Vol 44 (9) ◽

pp. 1925-1930 ◽

Cited By ~ 41

Author(s):

Christopher Heeschen ◽

Britta U Goldmann ◽

Robert H Moeller ◽

Christian W Hamm

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Rapid Test ◽

Cardiac Troponin I ◽

Diagnostic Sensitivity ◽

Diagnostic Efficacy ◽

Coronary Syndrome ◽

Bedside Test

Abstract Detection of cardiac troponin I (cTnI) in patients suspected of having an acute coronary syndrome is highly predictive for an adverse outcome. We evaluated a bedside test for cTnI that uses a polyclonal capture antibody and two monoclonal indicator antibodies. Clinical studies were performed in patients with acute coronary syndrome and patients with chest pain but no evidence of acute myocardial injury. The whole-blood, 15-minute assay had a concordance of 98.9% with an ELISA for cTnI and a detection limit of 0.14 μg/L, and the device tolerated temperatures between 4 °C and 37 °C. Diagnostic sensitivity for myocardial infarction at arrival (3.5 ± 2.7 h after onset of symptoms) was 60% [creatine kinase isoenzyme MB (CK-MB) mass, 48%; CK activity, 36%; P < 0.01], and 4 h later, diagnostic sensitivity was 98% (CK-MB mass, 91%; CK activity, 61%; P < 0.01). In 38% of the patients with unstable angina, at least one positive cTnI test was found (CK-MB mass, 4%; CK activity, 2%). No false-positive test results were found in renal failure or injury of skeletal muscle. We conclude that the diagnostic efficacy of the cTnI rapid test was comparable with the cTnI ELISA and superior to CK-MB determination. Therefore, this device could facilitate decision-making in patients with chest pain at the point of care.

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Coronary artery disease in patients with chest pain who have low-risk clinical characteristics and negative cardiac troponin I

The American Journal of Emergency Medicine ◽

10.1053/ajem.2001.23128 ◽

2001 ◽

Vol 19 (2) ◽

pp. 118-121 ◽

Cited By ~ 6

Author(s):

Graham S. Hillis ◽

Craig Oliner ◽

Brian J. O'Neil ◽

Vinu Pansuriya ◽

Pamela Taggart ◽

...

Keyword(s):

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Cardiac Troponin ◽

Clinical Characteristics ◽

Troponin I ◽

Cardiac Troponin I ◽

Low Risk ◽

Artery Disease

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The role of cardiac troponin I in determining the necessity for exercise electrocardiography in low risk patients with chest pain

Irish Journal of Medical Science (1971 -) ◽

10.1007/bf03167689 ◽

2000 ◽

Vol 169 (3) ◽

pp. 173-175 ◽

Cited By ~ 1

Author(s):

S. M. Fleming ◽

M. Divilly ◽

P. I. Chakravarthi ◽

H. Grimes ◽

K. Daly

Keyword(s):

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Low Risk ◽

Exercise Electrocardiography ◽

Risk Patients

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The effects of Allopurinol on levels of cardiac troponin Following Non-ST Elevation Myocardial Infarction: A Pilot Randomized Clinical Trial

Pharmaceutical Sciences ◽

10.34172/ps.2021.14 ◽

2021 ◽

Author(s):

Sajad Khiali ◽

Parvin Sarbakhsh ◽

Sina Mashayekhi ◽

Elham Mohamadrezapour ◽

Samaneh Dousti ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Trial ◽

Randomized Clinical Trial ◽

Cardiac Troponin ◽

Myocardial Injury ◽

Standard Treatment ◽

Troponin I ◽

Cardiac Troponin I ◽

St Elevation Myocardial Infarction ◽

St Elevation

Purpose: Given the potential anti-ischemic effects of allopurinol, we aimed to assess whether allopurinol administration may reduce myocardial injury following non-ST elevation myocardial infarction (NSTEMI). Methods: A randomized clinical trial (RCT) was conducted on 100 individuals with NSTEMI. The intervention group (n=50) received 600 mg oral allopurinol at the time of diagnosis of NSTEMI, followed by 300 mg every day for two next days and the standard treatment of NSTEMI, while the control group (n=50) received only the standard treatment. Serum concentrations of cardiac troponin I (cTnI) were measured at baseline, and 8, 16, 24, and 32 hours after the treatment. Results: The baseline demographic and clinical data of the patients were not statistically different between the intervention and control groups (all P > 0.05). The comparing estimated marginal mean ± standard error for cardiac troponin I (cTnI) levels revealed no significant difference between the study groups (2.93 ± .27, 2.25 ± .27; P=0.082). The linear mixed model results showed that the interaction of time and group was not statistically different (P=0.751). Moreover, there was a decreasing trend over time for cTnI in both groups (P=0.039). Conclusion: The present pilot RCT did not support the potential cardio-protective benefits of allopurinol administration on decreasing myocardial injury following NSTEMI.

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Evaluation of Innotrac Aio! Second-Generation Cardiac Troponin I Assay: The Main Characteristics for Routine Clinical Use

Journal of Automated Methods and Management in Chemistry ◽

10.1155/jammc/2006/39325 ◽

2006 ◽

Vol 2006 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

P. Hedberg ◽

J. Valkama ◽

E. Suvanto ◽

S. Pikkujämsä ◽

K. Ylitalo ◽

...

Keyword(s):

Rheumatoid Factor ◽

Whole Blood ◽

Cardiac Troponin ◽

First Generation ◽

Second Generation ◽

Troponin I ◽

Reference Group ◽

Rapid Test ◽

Cardiac Troponin I ◽

The Stability

The availability of a simple, sensitive, and rapid test using whole blood to facilitate processing and to reduce the turnaround time could improve the management of patients presenting with chest pain. The aim of this study was an evaluation of the Innotrac Aio! second-generation cardiac troponin I (cTnI) assay. The Innotrac Aio! second-generation cTnI assay was compared with the Abbott AxSYM first-generation cTnI, Beckman Access AccuTnI, and Innotrac Aio! first-generation cTnI assays. We studied serum samples from 15 patients with positive rheumatoid factor but with no indication of myocardial infarction (MI). Additionally, the stability of the sample with different matrices and the influence of hemodialysis on the cTnI concentration were evaluated. Within-assay CVs were 3.2%–10.9%, and between-assay precision ranged from 4.0% to 17.2% for cTnI. The functional sensitivity(CV=20%)and the concentration giving CV of 10% were approximated to be 0.02 and 0.04, respectively. The assay was found to be linear within the tested range of 0.063–111.6μg/L. The correlations between the second-generation Innotrac Aio!, Access, and AxSYM cTnI assays were good (rcoefficients 0.947–0.966), but involved differences in the measured concentrations, and the biases were highest with cTnI at low concentrations. The second-generation Innotrac Aio! cTnI assay was found to be superior to the first-generation assay with regard to precision in the low concentration range. The stability of the cTnI level was best in the serum, lithium-heparin plasma, and lithium-heparin whole blood samples (n=10, decrease<10%in 24 hours at+20°Cand at+4°C. There was no remarkable influence of hemodialysis on the cTnI release. False-positive cTnI values occurred in the presence of very high rheumatoid factor values, that is, over 3000 U/L. The 99th percentile of the apparently healthy reference group was≤0.03 μg/L. The results demonstrate the very good analytical performance of the second-generation Innotrac Aio! cTnI assay.

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Comparison between Emergency Severity Index plus peak flow meter and Emergency Severity Index in the dyspneic patients with chronic obstructive pulmonary disease: A randomized clinical trial

Turkish Journal of Emergency Medicine ◽

10.1016/j.tjem.2019.01.003 ◽

2019 ◽

Vol 19 (2) ◽

pp. 68-72 ◽

Cited By ~ 1

Author(s):

Mahin Hamechizfahm Roudi ◽

Javad Malekzadeh ◽

Mohsen Ebrahimi ◽

Amir Mirhaghi ◽

MohammadTaghi Shakeri

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Clinical Trial ◽

Randomized Clinical Trial ◽

Pulmonary Disease ◽

Peak Flow ◽

Severity Index ◽

Chronic Obstructive ◽

Emergency Severity Index ◽

Flow Meter ◽

Obstructive Pulmonary Disease

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Study of Cardiac Troponin I level in Acute Coronary Syndrome and its correlation with Left Ventricular Systolic Function

Cardiovascular Journal ◽

10.3329/cardio.v12i1.43415 ◽

2019 ◽

Vol 12 (1) ◽

pp. 24-29

Author(s):

Mohammad Jakir Hossain ◽

Khondoker Asaduzzaman ◽

Solaiman Hossain ◽

Muhammad Badrul Alam ◽

Nur Hossain

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Systolic Function ◽

Left Ventricular ◽

Cardiac Troponin I ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Coronary Syndrome

Background: In the diagnosis of acute coronary syndrome, cardiac troponin I is highly reliable and widely available biomarker. Serum level of cardiac troponin I is related to amount of myocardial damage and also closely relates to infarct size. Our aim of the study is to find out the relationship between cardiac troponin I and left ventricular systolic function after acute coronary syndrome. Methods: Total of 132 acute coronary syndrome patients were included in this study after admission in coronary care unit of Sir Salimullah Medical College, Mitford Hospital. Troponin I level was measured at admission and left ventricular ejection fraction (LVEF) was measured by echocardiography between 12-48 hours of onset of chest pain. Results: There was negative correlation between Troponin I at 12 to 48 hours of chest pain with LVEF in these study patients. With a cutoff value of troponin I e”6.8 ng/ml in STEMI patients there is a significant negative relation between 12 to 48 hrs troponin I and LVEF (p<0.001). Sensitivity of troponin I e” 6.8 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% in STEMI was 93.75% and specificity was 77.78%. In NSTEMI sensitivity of troponin I e” 4.5 ng/ml between 12 to 48 hours of chest pain in predicting LVEF <50% was 65% and specificity was 54.05%. Conclusion: Serum troponin I level had a strong negative correlation with left ventricular ejection fraction after acute coronary syndrome and hence can be used to predict the LVEF in this setting. Cardiovasc. j. 2019; 12(1): 24-29

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Emergency department triage of patients with acute chest pain: definition of cardiac troponin I decisional value to manage patients without electrocardiographic evidence of ischemia

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2004.094 ◽

2004 ◽

Vol 42 (5) ◽

Cited By ~ 1

Author(s):

Pascale Beyne ◽

Erik Bouvier ◽

Patrick Werner ◽

Pierre Bourgoin ◽

Damien Logeart ◽

...

Keyword(s):

Chest Pain ◽

Cardiac Troponin ◽

Troponin I ◽

Acute Chest Pain ◽

Final Diagnosis ◽

Cardiac Troponin I ◽

Reference Limit ◽

Coronary Syndrome ◽

Definition Of ◽

Upper Reference Limit

AbstractThe aim of this study was to define the use of a new cardiac troponin I (cTnI) assay for emergency patients with chest pain and no specific electrocardiographic changes consistent with the presence of ischemia. Patients (n=106) admitted in Emergency/Cardiology Departments for chest pain and suspicion of acute coronary syndrome (ACS) were randomized into two diagnosis groups (ACS or non-ACS) by two independent cardiologists. cTnI measurements were performed at admission, and 6 hours and 12 hours later with a new generation assay (Access AccuTnI, Beckman Coulter). Using an upper reference limit of 0.04 μg/l, 27 patients had a cTnI elevation not related to the final diagnosis of ischemia; the positive predictive value (PPV) was 67% with specificity 48%. The decisional value was re-defined and set at 0.16 μg/l, a concentration corresponding to the 99th percentile of the non-ACS patient group. Precision (coefficient of variation) was 8% at this level, PPV 97% and specificity 98%. This new decisional value is now used in our institution and could be included in standard care guidelines to improve the management of patients presenting chest pain in emergency departments.

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