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Sökning: id:"swepub:oai:lup.lub.lu.se:39208f8d-a58b-4aa0-9a84-b002dc86986a" > A Single High-Sensi...

A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out Myocardial Infarction

Gilje, Patrik (författare)
Lund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
Mohammad, Moman A. (författare)
Lund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
Roos, Andreas (författare)
Karolinska Institutet,Karolinska Institute,Karolinska University Hospital,Karolinska Inst, Dept Med, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Emergency & Reparat Med, Stockholm, Sweden.
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Ekelund, Ulf (författare)
Lund University,Lunds universitet,Akutsjukvård,Forskargrupper vid Lunds universitet,Emergency medicine,Lund University Research Groups,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Internal & Emergency Med, Lund, Sweden.
Björk, Jonas (författare)
Lund University,Lunds universitet,Avdelningen för arbets- och miljömedicin,Institutionen för laboratoriemedicin,Medicinska fakulteten,EPI@LUND,Forskargrupper vid Lunds universitet,LU profilområde: Naturbaserade framtidslösningar,Lunds universitets profilområden,Division of Occupational and Environmental Medicine, Lund University,Department of Laboratory Medicine,Faculty of Medicine,Lund University Research Groups,LU Profile Area: Nature-based future solutions,Lund University Profile areas,Lund Univ, Occupat & Environm Med, Lund, Sweden.
Lindahl, Bertil, 1957- (författare)
Uppsala universitet,Uppsala University,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR)
Holzmann, Martin (författare)
Karolinska Institute,Karolinska University Hospital,Karolinska Inst, Dept Med, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Emergency & Reparat Med, Stockholm, Sweden.
Mokhtari, Arash (författare)
Lund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,NPWT teknologin,Forskargrupper vid Lunds universitet,Skonsammare hjärtkirurgi,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,NPWT technology,Lund University Research Groups,Less invasive cardiac surgery,Skåne University Hospital,Lund Univ, Skane Univ Hosp, Dept Cardiol, Lund, Sweden.
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 (creator_code:org_t)
Hindawi Publishing Corporation, 2024
2024
Engelska.
Ingår i: Emergency Medicine International. - : Hindawi Publishing Corporation. - 2090-2840 .- 2090-2859. ; 2024
Relaterad länk:
http://dx.doi.org/10... (free)
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https://doi.org/10.1...
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https://urn.kb.se/re...
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
Stäng  
  • Background. Ruling out acute myocardial infarction (AMI) in the emergency department (ED) is challenging. Studies have shown that a high-sensitivity cardiac troponin T (hs-cTnT) <5 ng/L or <6 ng/L at presentation (0 h) can be used to rule out AMI. The objective of this study was to identify whether an even higher hs-cTnT threshold can be used for a safe rule out of AMI in the ED. Methods. The derivation cohort consisted of 24,973 ED patients with a primary complaint of chest pain. In this cohort, we identified the highest concentration of 0 h hs-cTnT that corresponded to a negative predictive value (NPV) of ≥99.5% for the primary endpoint of AMI/all-cause death within 30 days and the secondary endpoint of all-cause death within one year. The results were validated in two cohorts consisting of 132,021 and 1167 ED chest pain patients. Results. The 0 h hs-cTnT threshold corresponding to a NPV of ≥99.5% for the primary endpoint was <9 ng/L (NPV: 99.6% and 95% CI: 99.5-99.7). This cutoff provided a sensitivity of 96.2% (95% CI: 95.2-97.1) and identified 59.7% of the patients as low risk compared to 35.8% and 43.9% with a 0 h hs-cTnT <5 ng/L and <6 ng/L, respectively. The results were similar in the validation cohorts and seemed to perform even better in patients where the 0 h hs-cTnT was measured >3 h after symptom onset and in those with a nonischemic ECG and nonhigh risk history. Conclusions. A 0 h hs-cTnT cutoff of <9 ng/L safely rules out AMI/death within 30 days in a majority of chest pain patients and is a more effective strategy than the currently recommended <5 ng/L and <6 ng/L cutoffs. This trial is registered with NCT03421873.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

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