Abstract 14573: Is a Policy of Measuring Hs-TnT in All Comers to Emergency Department With Suspected Myocardial Infarction Useful?
Background: The best use of high sensitivity troponin T (hs-TnT) in Emergency Department (ED) is still a matter of debate. Our aim was to evaluate the efficacy of a policy based on the measure of hs-TnT in all comers to ED with chest pain or other condition at risk of myocardial infarction (MI) according to the physician in charge of the ED.
Methods: We examined the database of all pts admitted to our ED during the first four months of 2011 who had hs-TnT measured upon arrival. During this time interval 3000 pts were screened with hs-TnT.
Results: Only 150 pts (5%) out of 3000 were discharged with a diagnosis of Acute Coronary Syndrome (ACS), either STEMI and NSTE-ACS. 614 pts (20%) had a diagnosis of cardiovascular disease (CVD) different from ACS, mainly heart failure (141 pts), atrial fibrillation (151 pts), other arrhythmias (169 pts) and hypertensive crisis (100 pts). 390 pts (13%) were discharged with diagnosis of chest pain of not cardiac origin, 220 pts (7%) had a diagnosis of syncope of not cardiac origin and a total of 1011 pts (34%) had a diagnosis of miscellanous conditions.
Although the mean levels of hs-TnT in the ACS populations was much higher than in the other groups (0.293 ng/ml ), no cut-off value was found to allow a definite diagnosis of ACS ruling-out false positive conditions.
A significantly higher rate of readmission to ED during the subsequent 6 months was observed in pts presenting with a value of hs-TnT above 0,014 ng/ml at first contact with ED.
138 (12%) out of the 1168 positive hs-TnT pts at first contact vs 118 pts (6%) out of the 1832 negative hs-TnT pts at first contact (p<0.001) have been readmitted to the ED.
A higher number of ACS was observed in positive hs-TnT pts at first contact vs negative hs-TnT pts at first contact (8 pts vs 2 pts, p=0. 017). Furthermore, 42 positive hs-TnT pts at first contact vs 38 negative hs-TnT pts at first contact (p=0.019) had a diagnosis of other CVD at readmission.
Conclusion: Our data suggest that a policy of hs-TnT measuring in all comers with suspected cardiac ischemia for any reason leads to correct identification of MI pts in only a small percentage of the population assessed and confirm that numerous other conditions are associated with elevation in hs-TnT, but also that subject with positive hs-TnT are at higher risk after discharge.
- © 2013 by American Heart Association, Inc.