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Sensitivity of undetectable level of high-sensitivity troponin T at presentation in a large non-ST-segment elevation myocardial infarction cohort of early presenters
Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, SE-11883 Stockholm, Sweden;Soder Sjukhuset, Dept Cardiol, SE-11883 Stockholm, Sweden.
Karolinska Inst, Danderyd Univ Hosp, Dept Clin Sci, SE-18288 Danderyd, Sweden.
Capio St Gorans Hosp, Dept Emergency Med, SE-11281 Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 284, p. 6-11Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We aimed to evaluate the diagnostic sensitivity for myocardial infarction (MI) when using an undetectable level of high-sensitivity cardiac troponin T (hs-cTnT < 5 ng/L) at presentation combined with a non-ischemic electrocardiogram (ECG), to rule out MI in a non-ST-segment elevation MI (NSTEMI) cohort presenting ≤2 h from symptom onset. We also aimed to compare baseline characteristics and 30-day outcome in NSTEMI patients presenting with and without hs-cTnT < 5 ng/L.

METHODS: All patients admitted to five centers in Sweden 2011-2015, after the introduction of hs-cTnT, who presented ≤2 h from symptom onset and received a final diagnosis of NSTEMI, were identified through the SWEDEHEART registry. These data and data of hs-cTnT levels were verified in the hospitals' medical records. The registry provided baseline and outcome data.

RESULTS: Twenty-four (2.6%) of 911 NSTEMI patients presented with hs-cTnT < 5 ng/L. In patients presenting >1-≤2 h from symptom onset the sensitivity for MI when combining hs-cTnT and ECG was 99.4% (95% CI 98.4%-99.8%). In patients presenting ≤1 h, and in patients aged ≤65 years without prior MI, the sensitivity was insufficient. NSTEMI patients presenting with hs-cTnT < 5 ng/L were younger and had less often a prior MI. A total of 62.5 vs. 63.5% of the NSTEMI patients presenting with and without hs-cTnT < 5 ng/L underwent revascularization within 30 days and 4.5 and 3.2% died respectively.

CONCLUSIONS: Hs-cTnT < 5 ng/L at presentation combined with a non-ischemic ECG may be used to rule out MI in patients presenting as early as >1 h from symptom onset with a sufficient sensitivity.

Place, publisher, year, edition, pages
2019. Vol. 284, p. 6-11
Keywords [en]
Diagnosis, Emergency department, High-sensitivity cardiac troponin, Myocardial infarction, Rule-out algorithm, Sensitivity
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-374215DOI: 10.1016/j.ijcard.2018.10.088ISI: 000462025400002PubMedID: 30413299OAI: oai:DiVA.org:uu-374215DiVA, id: diva2:1280394
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-05-08Bibliographically approved

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