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Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation
BACKGROUND: We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the associatio...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott, Williams & Wilkins
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654725/ https://www.ncbi.nlm.nih.gov/pubmed/29432370 http://dx.doi.org/10.1097/HPC.0000000000000138 |
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author | Pettersson, Anna Ljung, Lina Johansson, Caroline Heilborn, Umut Jernberg, Tomas Frick, Mats Eggers, Kai M. Lindahl, Bertil Linder, Rikard Martinsson, Arne Svensson, Per |
author_facet | Pettersson, Anna Ljung, Lina Johansson, Caroline Heilborn, Umut Jernberg, Tomas Frick, Mats Eggers, Kai M. Lindahl, Bertil Linder, Rikard Martinsson, Arne Svensson, Per |
author_sort | Pettersson, Anna |
collection | PubMed |
description | BACKGROUND: We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome. METHODS: All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within >30 to ≤90 minutes were followed for 30 days regarding admission, readmission, myocardial infarction (MI), and death. RESULTS: A total of 1091 patients were included. Dynamic 1-hour changes in hs-cTnT defined as an increase or decrease of ≥3 ng/L occurred in 23 patients (2.1%). Fifteen patients (65.2%) in the dynamic group were admitted, compared with 148 patients (13.9%) in the nondynamic group (P < 0.001). Four of the admitted patients (26.7%) in the dynamic and 1 (0.7%) in the nondynamic group were diagnosed with an MI (P < 0.001). No death or MI occurred within 30 days among those discharged from the ED. CONCLUSIONS: Dynamic 1-hour changes in hs-cTnT were uncommon but associated with a higher rate of admission and of MI in an unselected population of chest pain patients with a nonelevated hs-cTnT at presentation. Lack of dynamic changes makes MI highly unlikely, and a 1-hour measurement may facilitate an early rule out of MI but should be used together with clinical assessment. |
format | Online Article Text |
id | pubmed-7654725 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Lippincott, Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-76547252020-11-12 Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation Pettersson, Anna Ljung, Lina Johansson, Caroline Heilborn, Umut Jernberg, Tomas Frick, Mats Eggers, Kai M. Lindahl, Bertil Linder, Rikard Martinsson, Arne Svensson, Per Crit Pathw Cardiol Original Articles BACKGROUND: We aimed to evaluate the use of a 1-hour measurement of high-sensitivity cardiac troponin T (hs-cTnT) in an emergency department (ED) population of chest pain patients with a nonelevated baseline hs-cTnT and to examine the prevalence of early dynamic changes in hs-cTnT and the association with admission rate, diagnosis, and outcome. METHODS: All patients with a chief complaint of chest pain presenting to the ED of Karolinska University Hospital, Solna, Sweden, from December 2014 to September 2015 who had a baseline hs-cTnT of ≤14 ng/L and a second value obtained within >30 to ≤90 minutes were followed for 30 days regarding admission, readmission, myocardial infarction (MI), and death. RESULTS: A total of 1091 patients were included. Dynamic 1-hour changes in hs-cTnT defined as an increase or decrease of ≥3 ng/L occurred in 23 patients (2.1%). Fifteen patients (65.2%) in the dynamic group were admitted, compared with 148 patients (13.9%) in the nondynamic group (P < 0.001). Four of the admitted patients (26.7%) in the dynamic and 1 (0.7%) in the nondynamic group were diagnosed with an MI (P < 0.001). No death or MI occurred within 30 days among those discharged from the ED. CONCLUSIONS: Dynamic 1-hour changes in hs-cTnT were uncommon but associated with a higher rate of admission and of MI in an unselected population of chest pain patients with a nonelevated hs-cTnT at presentation. Lack of dynamic changes makes MI highly unlikely, and a 1-hour measurement may facilitate an early rule out of MI but should be used together with clinical assessment. Lippincott, Williams & Wilkins 2018-03 2018-02-13 /pmc/articles/PMC7654725/ /pubmed/29432370 http://dx.doi.org/10.1097/HPC.0000000000000138 Text en Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Articles Pettersson, Anna Ljung, Lina Johansson, Caroline Heilborn, Umut Jernberg, Tomas Frick, Mats Eggers, Kai M. Lindahl, Bertil Linder, Rikard Martinsson, Arne Svensson, Per Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation |
title | Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation |
title_full | Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation |
title_fullStr | Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation |
title_full_unstemmed | Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation |
title_short | Experiences of a One-hour Algorithm in Chest Pain Patients With a Nonelevated Troponin T at Presentation |
title_sort | experiences of a one-hour algorithm in chest pain patients with a nonelevated troponin t at presentation |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7654725/ https://www.ncbi.nlm.nih.gov/pubmed/29432370 http://dx.doi.org/10.1097/HPC.0000000000000138 |
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