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Undetectable Troponin T Level in ED & Risk of Myocardial Infarction

Undetectable Troponin T Level in ED & Risk of Myocardial Infarction | Heart and Vascular Health | Scoop.it

Study to evaluate if an undetectable (<5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level & ECG without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).

Background  Chest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Because there is no rapid way to rule out MI, many patients are admitted to the hospital.

Methods  All patients who sought medical attention for chest pain and had at least 1 hs-cTnT analyzed during 2 years at the Karolinska University Hospital, Stockholm, Sweden, were included.

Results  14,636 patients. 8,907 (61%) had an initial hs-cTnT of <5 ng/l.

Among patients with a first hs-cTnT level of <5 ng/l, 1,704 (89%) had a second hs-cTnT level measured, which was <5 ng/l in 1,362 (90%) patients. Patients with a first hs-cTnT level of <5 ng/l and no MI within 30 days were admitted to the hospital for a total of 3,262 days, with a mean duration of hospital stay of 1.5 ± 3.0 days; 1,482 (77%) of these patients were discharged on the same or next day. The most common discharge diagnoses in patients with a first hs-cTnT level of <5 ng/l were nonspecific chest pain (50%), atrial fibrillation or supraventricular tachycardia (5.6%), and angina (5.1%).

Conclusions  All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED.

Seth Bilazarian, MD's insight:

The evaluation of chest pain in the emergency department and ability to rapidly evaluate patients, so low risk patients can be released for their comfort &  convenience and for health care cost savings is the "holy grail".  This paper does allot to get us closer. If patients had low level of troponin and a normal EKG there was no heart attack at 30 days in 99.8% and 100% of patients were alive.  Changing protocols in emergency departments will be difficult but achievable.

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Emergency Departments Can Identify Low-Risk Cardiac Patients Quickly

Emergency Departments Can Identify Low-Risk Cardiac Patients Quickly | Heart and Vascular Health | Scoop.it

Key Take Away for Patients:

When patients come to the Emergency Room with chest pain the main goal is to assess whether the patient is having a heart attack or at high risk for a heart attack.  In either circumstance the patient will be admitted overnight for treatment and testing.  Identifying low risk patients is a need, but has always been a concern because of the fear of missing someone who MIGHT be at risk and would be at risk for a heart attack or death if discharged.  Strategies to identify lower risk patients who can be discharged home and then seen for out-patient testing is an elusive goal, because there is no certainty.  This study discussed use of TIMI Risk score, EKG and 2 blood tests done 2 hours apart to identify lower risk patients. The negative predictive value of the diagnostic protocol was 99.7%: that means that for every 1000 considered low risk only 3 patients would be miscategorized.

TIMI Risk Score is online at http://goo.gl/vCJgh ;

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