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Erschienen in: Internal and Emergency Medicine 3/2019

29.11.2018 | IM - ORIGINAL

Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac troponin T levels at presentation

verfasst von: Andrea Fabbri, Cristina Bachetti, Filippo Ottani, Alice Morelli, Barbara Benazzi, Sergio Spiezia, Marco Cortigiani, Romolo Dorizzi, Allan S. Jaffe, Marcello Galvani

Erschienen in: Internal and Emergency Medicine | Ausgabe 3/2019

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Abstract

The reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection in ruling-out short- and long-term acute coronary events in subjects for suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not definitely settled. In a retrospective chart review analysis, 1001 subjects with hs-cTnT ≤ 14 ng/L out of 4053 subjects with hs-cTnT measured at Emergency Department (ED) presentation were recruited. The main outcome measure is fatal or non-fatal myocardial infarction (MI) within 30 days; secondary outcomes are MI or major acute coronary events (MACE) as a combination of MI or re-hospitalization for unstable angina within 1 year. In subjects with hs-cTnT < 5 ng/L [32.6% of cases, mean age 63 years (interquartile range 23)], no cases (0%, NPV 100%) had MI within 30 days, 2 cases (0.6%, NPV 99.4%) MI at 1-year, and 11 cases (3.4%, NPV 96.6%) MACE at 1-year. Patients with hs-cTnT < 5 ng/L would have benefited from a shortened decision (9.30 h and 53% overnight ED stay saved). Hs-cTnT < 5 ng/L is confirmed as safe for patients and comfortable for physicians in ruling out MI or MACE both at short and long term, suggesting that a sizable number of patients can be rapidly discharged without unnecessary diagnostic tests and ED observation.
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Metadaten
Titel
Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac troponin T levels at presentation
verfasst von
Andrea Fabbri
Cristina Bachetti
Filippo Ottani
Alice Morelli
Barbara Benazzi
Sergio Spiezia
Marco Cortigiani
Romolo Dorizzi
Allan S. Jaffe
Marcello Galvani
Publikationsdatum
29.11.2018
Verlag
Springer International Publishing
Erschienen in
Internal and Emergency Medicine / Ausgabe 3/2019
Print ISSN: 1828-0447
Elektronische ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-018-1996-6

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