PoplarV1, Main, Exploration, bibRecord, 001D14

High-sensitivity cardiac troponin t concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation.

Identifieur interne : 001D14 ( Main/Exploration ); précédent : 001D13; suivant : 001D15

High-sensitivity cardiac troponin t concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation.

Auteurs : Richard Body [Royaume-Uni] ; Gillian Burrows [Royaume-Uni] ; Simon Carley [Royaume-Uni] ; Louise Cullen [Australie] ; Martin Than [Nouvelle-Zélande] ; Allan S. Jaffe [États-Unis] ; Philip S. Lewis [Royaume-Uni]

Source :

Clinical chemistry [ 1530-8561 ] ; 2015.

RBID : pubmed:25979953

Descripteurs français

English descriptors

KwdEn :
- Acute Disease (MeSH), Aged (MeSH), Biomarkers (blood), Chest Pain (diagnosis), Electrocardiography (MeSH), Female (MeSH), Humans (MeSH), Length of Stay (MeSH), Limit of Detection (MeSH), Male (MeSH), Middle Aged (MeSH), Myocardial Infarction (blood), Myocardial Infarction (diagnosis), Predictive Value of Tests (MeSH), Prospective Studies (MeSH), ROC Curve (MeSH), Sensitivity and Specificity (MeSH), Troponin T (blood).
MESH :
- chemical , blood : Biomarkers, Troponin T.
- blood : Myocardial Infarction.
- diagnosis : Chest Pain, Myocardial Infarction.
- Acute Disease, Aged, Electrocardiography, Female, Humans, Length of Stay, Limit of Detection, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, ROC Curve, Sensitivity and Specificity.

Abstract

BACKGROUND

Initial reports suggest that concentrations of high-sensitivity cardiac troponin T (hs-cTnT) (Roche Diagnostics Elecsys(®)) below the limit of blank (LoB) (3 ng/L) or limit of detection (LoD) (5 ng/L) of the assay have almost 100% negative predictive value (NPV) for acute myocardial infarction (AMI), particularly among patients without electrocardiograph (ECG) evidence of ischemia. We aimed to prospectively validate those findings.

METHODS

We included adults presenting to the emergency department with suspected cardiac chest pain. Standard troponin T (cTnT) and hs-cTnT (both Roche Elecsys) were tested in samples drawn on arrival. The primary outcome was AMI, adjudicated by 2 investigators on the basis of clinical data and ≥12-h cTnT testing. We also evaluated diagnostic performance when AMI was readjudicated on the basis of hs-cTnT (≥12-h) concentrations.

RESULTS

Of 463 patients included, 79 (17.1%) had AMI. Twenty-four patients (5.2%) had hs-cTnT concentrations below the LoB, although none had AMI. Ninety-six patients (20.7%) had hs-cTnT concentrations below the LoD, 1 of whom had AMI. Thus, diagnostic sensitivity was 98.7% (95% CI 87.5%-98.6%) and NPV was 99.0% (95% CI 94.3%-100.0%). Of the 17.3% (n = 80) patients with hs-cTnT below the LoD and no ECG ischemia, none had AMI. Thus, diagnostic sensitivity was 100.0% (95% CI 95.4%-100.0%) and NPV was 100.0% (95% CI 95.5%-100.0%). Sensitivity and NPV were maintained when AMI was readjudicated on the basis of hs-cTnT.

CONCLUSIONS

Our findings confirm that patients with nonischemic ECG and undetectable hs-cTnT at presentation have a very low probability of AMI, although the proportion of patients affected was smaller than in previous research.

DOI: 10.1373/clinchem.2014.231530
PubMed: 25979953

Affiliations:

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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute Disease (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Biomarkers (blood)</term>
<term>Chest Pain (diagnosis)</term>
<term>Electrocardiography (MeSH)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Length of Stay (MeSH)</term>
<term>Limit of Detection (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Myocardial Infarction (blood)</term>
<term>Myocardial Infarction (diagnosis)</term>
<term>Predictive Value of Tests (MeSH)</term>
<term>Prospective Studies (MeSH)</term>
<term>ROC Curve (MeSH)</term>
<term>Sensitivity and Specificity (MeSH)</term>
<term>Troponin T (blood)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term>
<term>Courbe ROC (MeSH)</term>
<term>Douleur thoracique (diagnostic)</term>
<term>Durée du séjour (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Infarctus du myocarde (diagnostic)</term>
<term>Infarctus du myocarde (sang)</term>
<term>Limite de détection (MeSH)</term>
<term>Maladie aigüe (MeSH)</term>
<term>Marqueurs biologiques (sang)</term>
<term>Mâle (MeSH)</term>
<term>Sensibilité et spécificité (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Troponine T (sang)</term>
<term>Valeur prédictive des tests (MeSH)</term>
<term>Électrocardiographie (MeSH)</term>
<term>Études prospectives (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Biomarkers</term>
<term>Troponin T</term>
</keywords>
<keywords scheme="MESH" qualifier="blood" xml:lang="en"><term>Myocardial Infarction</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Chest Pain</term>
<term>Myocardial Infarction</term>
</keywords>
<keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Douleur thoracique</term>
<term>Infarctus du myocarde</term>
</keywords>
<keywords scheme="MESH" qualifier="sang" xml:lang="fr"><term>Infarctus du myocarde</term>
<term>Marqueurs biologiques</term>
<term>Troponine T</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Acute Disease</term>
<term>Aged</term>
<term>Electrocardiography</term>
<term>Female</term>
<term>Humans</term>
<term>Length of Stay</term>
<term>Limit of Detection</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Predictive Value of Tests</term>
<term>Prospective Studies</term>
<term>ROC Curve</term>
<term>Sensitivity and Specificity</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte d'âge moyen</term>
<term>Courbe ROC</term>
<term>Durée du séjour</term>
<term>Femelle</term>
<term>Humains</term>
<term>Limite de détection</term>
<term>Maladie aigüe</term>
<term>Mâle</term>
<term>Sensibilité et spécificité</term>
<term>Sujet âgé</term>
<term>Valeur prédictive des tests</term>
<term>Électrocardiographie</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Initial reports suggest that concentrations of high-sensitivity cardiac troponin T (hs-cTnT) (Roche Diagnostics Elecsys(®)) below the limit of blank (LoB) (3 ng/L) or limit of detection (LoD) (5 ng/L) of the assay have almost 100% negative predictive value (NPV) for acute myocardial infarction (AMI), particularly among patients without electrocardiograph (ECG) evidence of ischemia. We aimed to prospectively validate those findings.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We included adults presenting to the emergency department with suspected cardiac chest pain. Standard troponin T (cTnT) and hs-cTnT (both Roche Elecsys) were tested in samples drawn on arrival. The primary outcome was AMI, adjudicated by 2 investigators on the basis of clinical data and ≥12-h cTnT testing. We also evaluated diagnostic performance when AMI was readjudicated on the basis of hs-cTnT (≥12-h) concentrations.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Of 463 patients included, 79 (17.1%) had AMI. Twenty-four patients (5.2%) had hs-cTnT concentrations below the LoB, although none had AMI. Ninety-six patients (20.7%) had hs-cTnT concentrations below the LoD, 1 of whom had AMI. Thus, diagnostic sensitivity was 98.7% (95% CI 87.5%-98.6%) and NPV was 99.0% (95% CI 94.3%-100.0%). Of the 17.3% (n = 80) patients with hs-cTnT below the LoD and no ECG ischemia, none had AMI. Thus, diagnostic sensitivity was 100.0% (95% CI 95.4%-100.0%) and NPV was 100.0% (95% CI 95.5%-100.0%). Sensitivity and NPV were maintained when AMI was readjudicated on the basis of hs-cTnT.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>Our findings confirm that patients with nonischemic ECG and undetectable hs-cTnT at presentation have a very low probability of AMI, although the proportion of patients affected was smaller than in previous research.</p>
</div>
</front>
</TEI>
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<JournalIssue CitedMedium="Internet"><Volume>61</Volume>
<Issue>7</Issue>
<PubDate><Year>2015</Year>
<Month>Jul</Month>
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<Title>Clinical chemistry</Title>
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<Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Initial reports suggest that concentrations of high-sensitivity cardiac troponin T (hs-cTnT) (Roche Diagnostics Elecsys(®)) below the limit of blank (LoB) (3 ng/L) or limit of detection (LoD) (5 ng/L) of the assay have almost 100% negative predictive value (NPV) for acute myocardial infarction (AMI), particularly among patients without electrocardiograph (ECG) evidence of ischemia. We aimed to prospectively validate those findings.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">We included adults presenting to the emergency department with suspected cardiac chest pain. Standard troponin T (cTnT) and hs-cTnT (both Roche Elecsys) were tested in samples drawn on arrival. The primary outcome was AMI, adjudicated by 2 investigators on the basis of clinical data and ≥12-h cTnT testing. We also evaluated diagnostic performance when AMI was readjudicated on the basis of hs-cTnT (≥12-h) concentrations.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Of 463 patients included, 79 (17.1%) had AMI. Twenty-four patients (5.2%) had hs-cTnT concentrations below the LoB, although none had AMI. Ninety-six patients (20.7%) had hs-cTnT concentrations below the LoD, 1 of whom had AMI. Thus, diagnostic sensitivity was 98.7% (95% CI 87.5%-98.6%) and NPV was 99.0% (95% CI 94.3%-100.0%). Of the 17.3% (n = 80) patients with hs-cTnT below the LoD and no ECG ischemia, none had AMI. Thus, diagnostic sensitivity was 100.0% (95% CI 95.4%-100.0%) and NPV was 100.0% (95% CI 95.5%-100.0%). Sensitivity and NPV were maintained when AMI was readjudicated on the basis of hs-cTnT.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Our findings confirm that patients with nonischemic ECG and undetectable hs-cTnT at presentation have a very low probability of AMI, although the proportion of patients affected was smaller than in previous research.</AbstractText>
<CopyrightInformation>© 2015 American Association for Clinical Chemistry.</CopyrightInformation>
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<ForeName>Richard</ForeName>
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<AffiliationInfo><Affiliation>The University of Manchester, Oxford Road, Manchester, UK; Central Manchester University Hospitals Foundation NHS Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK; richard.body@manchester.ac.uk.</Affiliation>
</AffiliationInfo>
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<AffiliationInfo><Affiliation>Central Manchester University Hospitals Foundation NHS Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK; Manchester Metropolitan University, Hathersage Road, Manchester, UK;</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Cullen</LastName>
<ForeName>Louise</ForeName>
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</AffiliationInfo>
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<ForeName>Martin</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>University of Otago, Christchurch, New Zealand;</Affiliation>
</AffiliationInfo>
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<Author ValidYN="Y"><LastName>Jaffe</LastName>
<ForeName>Allan S</ForeName>
<Initials>AS</Initials>
<AffiliationInfo><Affiliation>Mayo Clinic and Mayo College of Medicine, Rochester, MN.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Lewis</LastName>
<ForeName>Philip S</ForeName>
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<AffiliationInfo><Affiliation>Stockport NHS Foundation Trust, Poplar Grove, Stockport, UK;</Affiliation>
</AffiliationInfo>
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<Language>eng</Language>
<GrantList CompleteYN="Y"><Grant><GrantID>PDF-2012-05-193</GrantID>
<Agency>Department of Health</Agency>
<Country>United Kingdom</Country>
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<ArticleDate DateType="Electronic"><Year>2015</Year>
<Month>05</Month>
<Day>15</Day>
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<ISSNLinking>0009-9147</ISSNLinking>
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<MeshHeading><DescriptorName UI="D002637" MajorTopicYN="N">Chest Pain</DescriptorName>
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<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
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<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
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<MeshHeading><DescriptorName UI="D007902" MajorTopicYN="N">Length of Stay</DescriptorName>
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<MeshHeading><DescriptorName UI="D057230" MajorTopicYN="N">Limit of Detection</DescriptorName>
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<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
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<MeshHeading><DescriptorName UI="D011237" MajorTopicYN="N">Predictive Value of Tests</DescriptorName>
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<MeshHeading><DescriptorName UI="D011446" MajorTopicYN="N">Prospective Studies</DescriptorName>
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<MeshHeading><DescriptorName UI="D020107" MajorTopicYN="N">Troponin T</DescriptorName>
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<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">25979953</ArticleId>
<ArticleId IdType="pii">clinchem.2014.231530</ArticleId>
<ArticleId IdType="doi">10.1373/clinchem.2014.231530</ArticleId>
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<affiliations><list><country><li>Australie</li>
<li>Nouvelle-Zélande</li>
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<region><li>Angleterre</li>
<li>Grand Manchester</li>
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<settlement><li>Manchester</li>
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<orgName><li>Université de Manchester</li>
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<tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Body, Richard" sort="Body, Richard" uniqKey="Body R" first="Richard" last="Body">Richard Body</name>
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<country name="États-Unis"><region name="Minnesota"><name sortKey="Jaffe, Allan S" sort="Jaffe, Allan S" uniqKey="Jaffe A" first="Allan S" last="Jaffe">Allan S. Jaffe</name>
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</country>
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High-sensitivity cardiac troponin t concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation.

High-sensitivity cardiac troponin t concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation.

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