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.