Rapid exclusion of AMI using a high-sensitivity troponin assay

January 01, 0001

Rapid exclusion of AMI using a high-sensitivity troponin assay

Subgroup analysis of recent evidence suggests that undetectable hs-cTnT may exclude AMI at presentation. This paper by researchers from the UK and the US sought to evaluate whether high sensitivity troponin (hs-cTnT) can immediately exclude acute myocardial infarction (AMI) at a novel ‘rule out' cut-off. In a cohort study, they prospectively enrolled patients with chest pain, evaluating them with standard troponin T and testing for hs-cTnT (Roche Diagnostics, Basel, Switzerland) at presentation. They also followed up patients for adverse events within 6 months.

Of 703 patients in the cohort study,18.5% had AMI, none of whom initially had undetectable hs-cTnT (sensitivity: 100.0%, negative predictive value: 100.0%). This strategy would rule out AMI in 27.7% of patients, 1.0% of whom died or had AMI within 6 months (1 periprocedural AMI, 1 noncardiac death). They evaluated this approach in an additional 915 patients in clinical practice. Only 1 patient (0.6%) with initially undetectable hs-cTnT had subsequent elevation (to 17 ng/l), giving a sensitivity of 99.8% and a negative predictive value of 99.4%.

The researchers concluded: "Undetectable hs- cTnT at presentation has very high negative predictive value, which may be considered to rule out AMI, identifying patients at low risk of adverse events. Pending further validation, this strategy may reduce the need for serial testing and empirical treatment, enabling earlier reassurance for patients and fewer unnecessary evaluations and hospital admissions."

This could be a great cost-saver, especially if part of point-of-care testing.


For the full abstract, click here.

Journal of the American College of Cardiology 58(13):1332-1339, 20 September 2011 © 2011 Elsevier B.V.
Rapid Exclusion of Acute Myocardial Infarction in Patients With Undetectable Troponin Using a High-Sensitivity Assay. Richard Body, Simon Carley, Garry McDowell et al. Correspondence to Richard Body: richard.body@manchester.ac.uk

Category: K. Circulatory. Keywords: acute coronary syndromes, acute myocardial infarction, diagnosis, high sensitivity, sensitivity and specificity, troponins, subgroup analysis, cohort study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 4 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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