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The Use of Very Low...
The Use of Very Low Concentrations of High-sensitivity Troponin T to Rule Out Acute Myocardial Infarction Using a Single Blood Test
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- Body, Richard (författare)
- Manchester Acad Hlth Sci Ctr, Cent Manchester Univ Hosp NHS Fdn Trust, Emergency Dept, Manchester, Lancs, England.;Univ Manchester, Cardiovasc Sci Res Grp, Oxford Rd, Manchester, Lancs, England.
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- Mueller, Christian (författare)
- Univ Spital Basel, Dept Cardiol, Basel, Switzerland.
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- Giannitsis, Evangelos (författare)
- Med Univ Klin Krehl Linik, Abt Innere Med Kardiol Angiol & Pneumol 3, Heidelberg, Germany.
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- Christ, Michael (författare)
- Klinikum Nurnberg Nord, Klin Notfallmed & Internist Intens Med, Nurnberg, Germany.
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- Ordonez-Llanos, Jorge (författare)
- Hosp Santa Creu & Sant Pau, IIB, Barcelona, Spain.;Univ Autonoma Barcelona, Barcelona, Spain.
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- de Filippi, Christopher R. (författare)
- Univ Maryland, Div Cardiol, Baltimore, MD 21201 USA.
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- Nowak, Richard (författare)
- Henry Ford West Bloomfield Hosp, West Bloomfield, MI USA.
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- Panteghini, Mauro (författare)
- Azienda Osped Luigi Sacco, Lab Anal Chim Clin, Milan, Italy.
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- Jernberg, Tomas (författare)
- Karolinska Institutet
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- Plebani, Mario (författare)
- Univ Padua, Lab Azienda Osped, Med Serv, Via Giustinianeo, Padua, Italy.
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- Verschuren, Franck (författare)
- Catholic Univ Louvain, Clin Univ St Luc, Dept Acute Med, Brussels, Belgium.
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- French, John K. (författare)
- Liverpool Hosp, Dept Cardiol, Liverpool, NSW, Australia.
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- Christenson, Robert (författare)
- Univ Maryland, Sch Med, Baltimore, MD 21201 USA.
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- Weiser, Silvia (författare)
- Roche Diagnost Germany, Penzberg, Germany.
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- Bendig, Garnet (författare)
- Roche Diagnost Germany, Penzberg, Germany.
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- Dilba, Peter (författare)
- Roche Diagnost Germany, Penzberg, Germany.
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- Lindahl, Bertil (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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Manchester Acad Hlth Sci Ctr, Cent Manchester Univ Hosp NHS Fdn Trust, Emergency Dept, Manchester, Lancs, England;Univ Manchester, Cardiovasc Sci Res Grp, Oxford Rd, Manchester, Lancs, England. Univ Spital Basel, Dept Cardiol, Basel, Switzerland. (creator_code:org_t)
- 2016-09-07
- 2016
- Engelska.
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Ingår i: Academic Emergency Medicine. - : Wiley. - 1069-6563 .- 1553-2712. ; 23:9, s. 1005-1013
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https://urn.kb.se/re...
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Abstract
Ämnesord
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- Background: Recent single-center and retrospective studies suggest that acute myocardial infarction (AMI) could be immediately excluded without serial sampling in patients with initial high-sensitivity cardiac troponin T (hs-cTnT) levels below the limit of detection (LoD) of the assay and no electrocardiogram (ECG) ischemia. Objective: We aimed to determine the external validity of those findings in a multicenter study at 12 sites in nine countries. Methods: TRAPID-AMI was a prospective diagnostic cohort study including patients with suspected cardiac chest pain within 6 hours of peak symptoms. Blood drawn on arrival was centrally tested for hs-cTnT (Roche; 99th percentile = 14 ng/L, LoD = 5 ng/L). All patients underwent serial troponin sampling over 4-14 hours. The primary outcome, prevalent AMI, was adjudicated based on sensitive troponin I (Siemens Ultra) levels. Major adverse cardiac events (MACE) including AMI, death, or rehospitalization for acute coronary syndrome with coronary revascularization were determined after 30 days. Results: We included 1,282 patients, of whom 213 (16.6%) had AMI and 231 (18.0%) developed MACE. Of 560 (43.7%) patients with initial hs-cTnT levels below the LoD, four (0.7%) had AMI. In total, 471 (36.7%) patients had both initial hs-cTnT levels below the LoD and no ECG ischemia. These patients had a 0.4% (n = 2) probability of AMI, giving 99.1% (95% confidence interval [CI] = 96.7% to 99.9%) sensitivity and 99.6% (95% CI = 98.5% to 100.0%) negative predictive value. The incidence of MACE in this group was 1.3% (95% CI = 0.5% to 2.8%). Conclusions: In the absence of ECG ischemia, the detection of very low concentrations of hs-cTnT at admission seems to allow rapid, safe exclusion of AMI in one-third of patients without serial sampling. This could be used alongside careful clinical assessment to help reduce unnecessary hospital admissions.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
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Body, Richard
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Mueller, Christi ...
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Giannitsis, Evan ...
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Christ, Michael
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Ordonez-Llanos, ...
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de Filippi, Chri ...
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Nowak, Richard
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Panteghini, Maur ...
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Jernberg, Tomas
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Plebani, Mario
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Verschuren, Fran ...
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French, John K.
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Christenson, Rob ...
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Weiser, Silvia
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Bendig, Garnet
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Dilba, Peter
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Lindahl, Bertil
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visa färre...
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