Document Detail

Implementation of high sensitivity cardiac troponin T measurement in the emergency department.
MedLine Citation:
PMID:  20932502     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: we examined the diagnostic performance of high sensitivity cardiac troponin T (cTnThs) measurement and its ability to predict risk in unselected patients presenting to the emergency department with acute chest pain.
METHODS: we conducted a retrospective analysis of 137 consecutive patients with chest pain (age range, 66 ± 16 years; 64% male). A final diagnosis of acute myocardial infarction was made using the "old" (cTnT fourth-generation assay, ≥ 0.04 microg/L) or the "new" cutpoint (cTnThs ≥ 0.014 microg/L).
RESULTS: the adjudicated final diagnosis of acute myocardial infarction significantly increased from 20 to 35 patients (a 75% increase) and troponin-positive nonvascular cardiac chest pain from 10 to 30 (a 200% increase) using cTnThs. The number of patients with unstable angina or troponin-negative nonvascular cardiac chest pain significantly decreased (P <.05). Diagnostic performance of cTnThs levels at admission was significantly higher compared to cTnT levels (area under the curve [AUC] 0.85 vs AUC 0.70; P <.05). cTnThs levels below the detection limit (<0.003 microg/L) had a negative predictive value of 100% to exclude acute myocardial infarction. The event rate during 6 months of follow-up was low in patients with cTnThs levels <0.014 microg/L, while patients with cTnT levels ≥ 0.04 μg/L were at increased, and patients with cTnThs ≥ 0.014 μg/L and cTnT <0.04 microg/L at intermediate risk of death or recurrent myocardial infarction (P = .002). Risk was highest in chest pain patients with dynamic changes of cTnThs levels >30%.
CONCLUSION: the introduction of cTnThs assay displays an excellent diagnostic performance for the workup of patients with chest pain at the time of their initial presentation. Even small increases of cTnThs indicate increased risk for death or myocardial infarction during follow-up.
Michael Christ; Steffen Popp; Hella Pohlmann; Michail Poravas; Dina Umarov; Ruth Bach; Thomas Bertsch
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  123     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1134-42     Citation Subset:  AIM; IM    
Copyright Information:
© 2010 Elsevier Inc. All rights reserved.
Department of Emergency and Critical Care Medicine, City Hospital Nuremberg, Nuremberg, Germany.
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MeSH Terms
Acute Disease
Aged, 80 and over
Area Under Curve
Biological Markers / blood
Chest Pain / etiology
Emergency Service, Hospital*
Middle Aged
Myocardial Infarction / blood*,  diagnosis*
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Troponin T / blood*
Reg. No./Substance:
0/Biological Markers; 0/Troponin T

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