Diagnostic utility of point of care high sensitive troponin-i assay for early diagnosis of acute myocardial infarction in patients presenting with acute onset chest pain in emergency departments. The early heart study
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Abstract
Background: An early diagnosis of myocardial infarction is highly important in the Emergency Department (ED). It facilitates rapid decision making and treatment and therefore improves the outcome in patients presenting with symptoms of chest pain.
Aims and objectives: To study diagnostic utility of new point of care high sensitive troponin-I assay in early diagnosis of acute myocardial infarction in patients presenting with acute chest pain.
Materials and methods: Forty six consecutive patients of acute onset chest pain who presented to our cardiac emergency department within three hours of symptom onset were enrolled for study. POC Hs Trop-I test was done on admission (0 hour), and after 3 hours if initial test result was negative. Quantitative troponin I (Q-Trop I) lab assay was done on admission (0 hour), 3 hours and 6 hours after admission. Six hour Q-Trop I assay was taken as gold standard for the initial diagnosis of AMI. The final adjudicated diagnosis of AMI was based on a composite of ECG changes (new ST segment or T wave changes, new onset LBBB), Troponin results, Echocardiography (new wall motion abnormality), angiographic findings (detection of a culprit lesion) and final chart review of observations made.
Results: Comparing the results of POC Hs Trop I results at 0 hour with the gold standard test we found the sensitivity of 97%, specificity of 100%, Positive Predictive Value (PPV) of 100% and Negative Predictive Value (NPV) of 92.3%. Sensitivity of POC Hs Trop I at 3 hours was better than POC Hs Trop I at 0 hour (97 vs. 100%) and equal to gold standard i.e. 100%. Specificity, PPV and NPV are 100% for POC Hs Trop I at 1 hour.
Conclusion: High sensitive Trop I test is rapid and reliable method to diagnose and exclude acute myocardial infarction in patients presenting with acute onset chest pain to our Emergency Departments.
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Mehta SR, Granger CB, Boden WE, Steg PG, Bassand JP, et al. (2009) Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 360: 2165–2175. Link: http://bit.ly/2IE0LM7
Milosevic A, Vasiljevic-Pokrajcic Z, Milasinovic D, Marinkovic J, Vukcevic V, et al. (2016) Immediate Versus Delayed Invasive Intervention for Non-STEMI Patients: The RIDDLE-NSTEMI Study. JACC Cardiovasc Interv 9: 541–549. Link: http://bit.ly/2TGGwDM
Nawar EW, Niska RW, Xu J (2007) National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data: 1-32. Link: http://bit.ly/2viToXk
Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, et al. (2015) ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37: 267-315.
Reichlin T, Irfan A, Twerenbold R, Reiter M, Hochholzer W, et al. (2011) Utility of absolute and relative changes in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Circulation 124: 136-145. Link: http://bit.ly/2W7ZO6u
Mueller M, Biener M, Vafaie M, Doerr S, Keller T, et al. (2012) Absolute and relative kinetic changes of high-sensitivity cardiac troponin T in acute coronary syndrome and in patients with increased troponin in the absence of acute coronary syndrome. Clin Chem 58: 209-218. Link: http://bit.ly/2IEsfRx
Neumann JT, Havulinna AS, Zeller T, Appelbaum S, Kunnas T, et al. (2014) Comparison of three troponins as predictors of future cardiovascular events-prospective results from the FINRISK and Bioma CaRE studies. PLoS One 9: e 90063. Link: http://bit.ly/2viTvlI
Apple FS, Ler R, Murakami MM (2012) Determination of 19 cardiac troponin I and T assay 99th percentile values from a common presumably healthy population. Clin Chem 58: 1574-1581. Link: http://bit.ly/2Q2LPev
Pickering JW, Greenslade JH, Cullen L, Flaws D, Parsonage W, et al. (2016) Validation of presentation and 3 h high-sensitivity troponin to rule-in and rule-out acute myocardial infarction. Heart 102: 1270-1278. Link: http://bit.ly/2Uc0wNJ
Apple FS, Parvin CA, Buechler KF, Christenson RH, Wu AH, et al. (2005) Validation of the 99th percentile cut-off independent of assay imprecision (CV) for cardiac troponin monitoring for ruling out myocardial infarction. Clin Chem 51: 2198-2200. Link: http://bit.ly/3cTR5L2
Tobias Reichlin J, Schindler C, Drexler B, Twerenbold R, Reiter M, et al. (2012) One-Hour Rule-out and Rule-in of Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin T. Arch Intern Med 172: 1211-1218. Link: http://bit.ly/2IBW2uj
Thygesen K, Alpert JS, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction (2007) Universal definition of myocardial infarction. Eur Heart J 28: 2525-2538. Link: http://bit.ly/2Q7T3hj
Apple FS, Smith SW, Pearce LA (2008) Use of the Centaur TnI-Ultra assay for detection of myocardial infarction and adverse events in patients presenting with symptoms suggestive of acute coronary syndrome, Clin Chem 54: 723-728. Link: http://bit.ly/2TKh0gE
Faizal P, Acharya LD, Padmakumar R, Boppanna K, Pandey S (2009) Evaluation of risk factors and in-hospital outcomes in patients with coronary artery disease in a tertiary care teaching hospital. International Journal of PharmTech Research CODEN (USA): IJPRIF 1: 1378-1386. Link: http://bit.ly/2vjYtPa
Mohanan PP, Mathew R, Harikrishnan S, Narayankrishnan M, Zachariah G, et al. (2013) Presentation, management, and outcomes of 25748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J Link: http://bit.ly/2IDJsdV
Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, et al. (2008) Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet 371: 1435-1442. Link: http://bit.ly/33afYOg
Gupta S, Gupta VK, Gupta R, Arora S, Gupta V (2012) Demographic profile and prevalence of risk factors and their correlation with STEMI, NSTEMI and premature CAD in documented CAD patients. J Preventive Cardiology 1: 4.
AlHabib KF, Hersi A, AlFaleh H, AlNemer K, AlSaif S, et al. (2011) Baseline characteristics, management practices, and in-hospital outcomes of patients with acute coronary syndromes: Results of the Saudi project for assessment of coronary events (SPACE) registry. Journal of the Saudi Heart Association 23: 233-239. Link: http://bit.ly/38KOcJs
RanjithN, Rosemary J, Pegoraro and Monique Zaahl G (2011) Risk Factors Associated with Acute Coronary Syndromes in South African Asian Indian Patients [The AIR Study]. J Clinic Experiment Cardiol 2: 163. Link: http://bit.ly/2TIDyP1
KhatriP, SimkhadaR (2015) Study on conventional risk factors in acute coronary syndrome. Journal of Universal College of Medical Sciences 3: 2. Link: http://bit.ly/2Q8esHk
Keller T, Zeller T, Ojeda F, Tzikas S, Lillpopp L, et al. (2011) Serial Changes in Highly Sensitive Troponin I Assay and Early Diagnosis of Myocardial Infarction. JAMA 306: 2684-2693. Link: http://bit.ly/2W1oSw2