Roos Andreas, Mohammad Moman A, Ekelund Ulf, Mokhtari Arash, Holzmann Martin J
Department of Medicine Solna, Framstegsgatan 21, Building D1:04, Karolinska Institutet, SE-171 64 Solna, Stockholm, Sweden.
Department of Emergency and Reparative Medicine, Hälsovägen 13, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
Eur Heart J Acute Cardiovasc Care. 2022 Mar 16;11(3):215-223. doi: 10.1093/ehjacc/zuab123.
The clinical usefulness of historical concentrations of high-sensitivity cardiac troponin T (hs-cTnT) is unknown. This study investigated the ability to rule out myocardial infarction (MI) with the use of historical hs-cTnT concentrations among patients with chest pain in the emergency department (ED).
The derivation cohort consisted of patients presenting with chest pain to nine different EDs (n = 60 071), where we included those with ≥1 hs-cTnT analysed at the index visit and ≥1 hs-cTnT results prior to the visit. We developed an algorithm to rule out MI within 30 days with a pre-specified target negative predictive value (NPV) of ≥99.5%. The performance was then validated in a separate cohort of ED chest pain patients (n = 10 994). A historical hs-cTnT < 12 ng/L and a < 3 ng/L absolute change between the historical and the index visit hs-cTnT had the best performance and ruled out 24 862 (41%) patients in the derivation cohort. In the validation cohort, these criteria identified 4764 (43%) low-risk patients in whom 18 (0.4%) MIs within 30 days occurred, and had an NPV for MI of 99.6% (99.4-99.8), a sensitivity of 96.9% (95.2-.2), and an LR- of 0.11 (0.07-0.14).
Combining a historical hs-cTnT with a single new hs-cTnT may safely rule out MI and thereby reduce the need for serial hs-cTnT measurements in ED patients with chest pain.
高敏心肌肌钙蛋白T（hs-cTnT）的历史浓度的临床实用性尚不清楚。本研究调查了在急诊科（ED）胸痛患者中使用hs-cTnT历史浓度排除心肌梗死（MI）的能力。
推导队列由前往9个不同急诊科就诊的胸痛患者组成（n = 60071），我们纳入了在首次就诊时分析了≥1次hs-cTnT且在就诊前有≥1次hs-cTnT检测结果的患者。我们开发了一种算法，以在30天内排除MI，预先设定的目标阴性预测值（NPV）≥99.5%。然后在另一组ED胸痛患者（n = 10994）中对该算法的性能进行验证。历史hs-cTnT < 12 ng/L以及历史与首次就诊hs-cTnT之间的绝对变化< 3 ng/L表现最佳，在推导队列中排除了24862名（41%）患者。在验证队列中，这些标准识别出4764名（43%）低风险患者，其中30天内发生了18例（0.4%）MI，MI的NPV为99.6%（99.4 - 99.8），灵敏度为96.9%（95.2 - 98.2），阴性似然比为0.11（0.07 - 0.14）。
将hs-cTnT历史浓度与单次新的hs-cTnT结果相结合可安全地排除MI，从而减少ED胸痛患者进行系列hs-cTnT检测的需求。
