Two-hour diagnostic algorithms for early assessment of patients with acute chest pain - Implications of lowering the cardiac troponin I cut-off to the 97.5th percentile

Eggers, Kai M.Uppsala universitet,Uppsala kliniska forskningscentrum (UCR) (författare)

Aims: Assessment of patients with suspected non-ST elevation myocardial infarction (NSTEMI) is based on cardiac troponin (cTn) levels with the 99th percentile as cut-off. However, cardiovascular risk starts already at lower troponin concentrations. We therefore, aimed to investigate the utility of 2-hour algorithms using the high-sensitivity cardiac troponin I (hs-cTnI) 97.5th percentile as cut-off which corresponds to the standard URL for most biomarkers. Methods: Hs-cTnI was measured at presentation and 2 h in 1624 chest pain patients. Diagnostic algorithms were developed applying hs-cTnI levels dichotomized at the 99th and 97.5th percentiles combined with hs-cTnI changes and/or ECG findings. Results: The prevalence of NSTEMI was 13.9%. The adjusted odds ratios for 1-year mortality were 2.7(95% CI 1.4-5.1) for the 99th percentile and 3.1 (95% CI 1.6-5.9) for the 97.5th percentile. The best-performing 99th percentile-based algorithms provided a positive predictive value (PPV) of 863% and a negative predictive value (NPV) of 993%. Using 97.5th percentile-based algorithms to define NSTEMI resulted in few reclassifications and yielded similar diagnostic estimates (PPV 85.4%, NPV 99.4%). Conclusion: The hs-cTnI 97.5th percentile integrated into 2-hour algorithms provided high diagnostic estimates and could, due to better prognostic properties serve as an alternative to the 99th percentile.

Aldous, Sally (författare)
Greenslade, Jaimi H. (författare)
Johnston, NinaUppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)ninjo389 (författare)
Lindahl, Bertil (författare)
Parsonage, William A. (författare)
Pickering, John W. (författare)
Than, Martin (författare)
Cullen, Louise (författare)
Uppsala universitetUppsala kliniska forskningscentrum (UCR) (creator_code:org_t)

Av författaren/redakt...: Eggers, Kai M.; Aldous, Sally; Greenslade, Jaim ...; Johnston, Nina; Lindahl, Bertil; Parsonage, Willi ...; visa fler...; Pickering, John ...; Than, Martin; Cullen, Louise; visa färre...

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