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Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac troponin T levels at presentation

  • Andrea Fabbri
  • Cristina Bachetti
  • Filippo Ottani
  • Alice Morelli
  • Barbara Benazzi
  • Sergio Spiezia
  • Marco Cortigiani
  • Romolo Dorizzi
  • Allan S. Jaffe
  • Marcello Galvani
IM - ORIGINAL

Abstract

The reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection in ruling-out short- and long-term acute coronary events in subjects for suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not definitely settled. In a retrospective chart review analysis, 1001 subjects with hs-cTnT ≤ 14 ng/L out of 4053 subjects with hs-cTnT measured at Emergency Department (ED) presentation were recruited. The main outcome measure is fatal or non-fatal myocardial infarction (MI) within 30 days; secondary outcomes are MI or major acute coronary events (MACE) as a combination of MI or re-hospitalization for unstable angina within 1 year. In subjects with hs-cTnT < 5 ng/L [32.6% of cases, mean age 63 years (interquartile range 23)], no cases (0%, NPV 100%) had MI within 30 days, 2 cases (0.6%, NPV 99.4%) MI at 1-year, and 11 cases (3.4%, NPV 96.6%) MACE at 1-year. Patients with hs-cTnT < 5 ng/L would have benefited from a shortened decision (9.30 h and 53% overnight ED stay saved). Hs-cTnT < 5 ng/L is confirmed as safe for patients and comfortable for physicians in ruling out MI or MACE both at short and long term, suggesting that a sizable number of patients can be rapidly discharged without unnecessary diagnostic tests and ED observation.

Keywords

Undetectable high-sensitivity cardiac troponin T Suspected non-ST-segment elevation acute coronary syndrome Emergency department Myocardial infarction 

Notes

Acknowledgements

We are grateful to Daniela Bellavista, Medical Project Manager, Roche Diagnostics Italy for helpful support.

Author contributions

AF and MG had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the results. All authors were involved in the study concept and design and statistical analyses. MC, BB, AM, SS and BC were responsible for collection, management, analyses and interpretation of the data. AF and MG conducted the statistical analyses and drafted the manuscript. All authors contributed substantially to its revision and agree to be accountable for all the aspects of the work. FO, ASJ and RD supervised the study. AF takes responsibility for the paper as a whole.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

Statement of human and animal rights

The authors declare that all contents in this study are in accordance with ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This is a retrospective study and for this type of study formal consent is not required.

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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2018

Authors and Affiliations

  • Andrea Fabbri
    • 1
  • Cristina Bachetti
    • 2
  • Filippo Ottani
    • 2
    • 5
  • Alice Morelli
    • 1
  • Barbara Benazzi
    • 1
  • Sergio Spiezia
    • 1
  • Marco Cortigiani
    • 1
  • Romolo Dorizzi
    • 3
  • Allan S. Jaffe
    • 4
  • Marcello Galvani
    • 2
    • 5
  1. 1.Dipartimento EmergenzaPresidio Ospedaliero Morgagni-Pierantoni, Azienda USL della RomagnaForlìItaly
  2. 2.Dipartimento Cardio-vascolare, Presidio Ospedaliero Morgagni-Pierantoni, AUSL della RomagnaForlìItaly
  3. 3.Laboratorio Unico AUSL della RomagnaPievesestina di CesenaItaly
  4. 4.Cardiovascular Department and Department of Laboratory Medicine and PathologyMayo Clinic and Medical SchoolRochesterUSA
  5. 5.Cardiovascular Research UnitFondazione Cardiologica SaccoForlìItaly

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