{"id":646,"date":"2019-02-07T18:56:00","date_gmt":"2019-02-07T18:56:00","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=646"},"modified":"2019-02-07T18:56:01","modified_gmt":"2019-02-07T18:56:01","slug":"undetectable-hs-ctnt","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=646","title":{"rendered":"Undetectable hs-cTnT"},"content":{"rendered":"\n

Body, R., Carley, S., McDowell, G.<\/strong>, Jaffe, A.S., France, M., Cruickshank, K., Wibberley, C., Nuttall, M. & Mackway-Jones, K. (2011) \u2018Rapid exclusion of acute myocardial infarction in patients\u2019 with undetectable troponin using a high sensitivity assay.\u2019 J Am Coll Cardiol<\/em>58 pp. 1332-1339.<\/p>\n\n\n\n

Objectives:<\/strong>This paper sought to evaluate whether high sensitivity troponin (hs-cTnT) can immediately exclude acute myocardial infarction (AMI) at a novel \u2018rule out\u2019 cut-off. <\/p>\n\n\n\n

Background:<\/strong>Subgroup analysis of recent evidence suggests that undetectable hs-cTnT may exclude AMI at presentation. <\/p>\n\n\n\n

Methods:<\/strong>In a cohort study, we prospectively enrolled patients with chest pain, evaluating them with standard troponin T and testing for hs-cTnT (Roche Diagnostics, Basel, Switzerland) at presentation. The primary outcome was a diagnosis of AMI. We also followed up patients for adverse events within 6 months. After subsequent clinical implementation of hs-cTnT, we again evaluated whether initially undetectable hs-cTnT ruled out a subsequent rise. <\/p>\n\n\n\n

Results:<\/strong>Of 703 patients in the cohort study, 130 (18.5%) had AMI, none of whom initially had undetectable hs-cTnT (sensitivity: 100.0%, 95% confidence interval [CI]: 95.1% to 100.0%, negative predictive value: 100.0%, 95% CI: 98.1% to 100.0%). This strategy would rule out AMI in 27.7% of patients, 2 (1.0%) of whom died or had AMI within 6 months (1 periprocedural AMI, 1 noncardiac death). We 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% (95% CI: 99.1% to 100.0%) and a negative predictive value of 99.4% (95% CI:96.6% to 100.0%). <\/p>\n\n\n\n

Conclusions<\/strong>: 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.<\/p>\n\n\nFull Text<\/span><\/a>","protected":false},"excerpt":{"rendered":"

Body, R., Carley, S., McDowell, G., Jaffe, A.S., France, M., Cruickshank, K., Wibberley, C., Nuttall, M. & Mackway-Jones, K. (2011) \u2018Rapid exclusion of acute myocardial infarction in patients\u2019 with undetectable troponin using a high sensitivity assay.\u2019 J Am Coll Cardiol58 pp. 1332-1339.<\/p>\n","protected":false},"author":1,"featured_media":595,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-aq","jetpack-related-posts":[{"id":732,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=732","url_meta":{"origin":646,"position":0},"title":"Novel hs-cTn Assay with a Single Serum Test in ED.","date":"July 21, 2019","format":false,"excerpt":"3D illustration of Heart - Part of Human Organic. Objectives To evaluate diagnostic accuracy of a high-sensitivity cardiac troponin I (hs-cTnI) assay for acute coronary syndromes (ACS) in the Emergency Department (ED). The assay has high precision at low concentrations and can detect cTnI in 96.8% of healthy individuals.\u00a0 Methods\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/07\/Screenshot-2019-07-21-at-10.53.34-e1563702957497.png?fit=364%2C500&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":136,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=136","url_meta":{"origin":646,"position":1},"title":"T-MACS","date":"December 22, 2017","format":false,"excerpt":"Body, R., Carlton, E., Sperrin, M., Lewis, P.S., Burrows, G., Carley, S., McDowell, G., Buchan, I., Greaves, K. & Mackway-Jones, K. (2017). Troponin only Manchester Acute Coronary Syndromes (T-MACS) decision aid: single biomarker re-derivation and external validation in three cohorts. Emerg Med J 34 pp. 349-356 Background The original Manchester\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2017\/12\/Cardiac-Marker-Test-Pages-300x200.png?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":624,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=624","url_meta":{"origin":646,"position":2},"title":"P-Selectin in AMI","date":"February 7, 2019","format":false,"excerpt":"Body, R., Pemberton, P., Ali, F.,\u00a0McDowell, G., Carley, S., Smith, A. & Mackway-Jones, K. (2011) \u2018Low soluble P-selectin may facilitate early exclusion of acute myocardial infarction.\u2019\u00a0Clin Chem Acta412 pp. 614-618. Background:Suspected cardiac chest pain accounts for over 25% of medical admissions but, as only a minority have acute coronary syndromes,\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/P-Selectin-1-e1549807984127.png?fit=400%2C333&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":641,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=641","url_meta":{"origin":646,"position":3},"title":"A FABP-ulous rule out strategy","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Wibberley, C., Ferguson, J. & Mackway-Jones, K. (2011) \u2018A FABP-ulous rule out strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction.\u2019\u00a0Resuscitation82 pp. 1041-1046.\u00a0 Objective:Many Emergency Departments (EDs) utilise \u2018triple marker\u2019 testing with CK-MB, myoglobin and troponin I (cTnI) to\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Quanti-HFABP-e1549807872944.png?fit=400%2C341&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":654,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=654","url_meta":{"origin":646,"position":4},"title":"Does Troponin Cut-off Matter?","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Ferguson, J. & Mackway-Jones, K. (2010) \u2018Diagnosing acute myocardial infarction with troponins: how low can you go?\u2019\u00a0Emerg Med J. 27 pp. 292-296. 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In the appropriate clinical context, the detection of a\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/646"}],"collection":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=646"}],"version-history":[{"count":2,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/646\/revisions"}],"predecessor-version":[{"id":649,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/646\/revisions\/649"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/media\/595"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=646"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}