Abstract 16833: Immediate Rule-out of Acute Myocardial Infarction Using Electrocardiogram and Baseline High-sensitivity Troponin I
Background: Current guidelines recommend serial troponin measurements using a 3-hour or 1-hour algorithm to rule-out acute myocardial infarction (AMI). In this study we evaluate the diagnostic performance of a single high-sensitivity troponin I (hs-TnI) measurement combined with a non-ischaemic ECG directly at admission to exclude AMI.
Methods: We measured baseline hs-TnI in 1,216 patients with suspected AMI. Patients with ST-elevation AMI were exlcuded from further analyses (n=60). Different hs-TnI cutoff concentrations were evaluated and combined with the information of a non-ischaemic ECG. We calculated the negative predictive value (NPV) to exclude AMI. All patients were followed for up to 2 years. The results were validated in 2 independent cohorts of patients with suspected AMI in 3,566 patients.
Results: The mean age of our study population was 64 years, the median follow-up time was 525 days. 216 patients were diagnosed with non-ST-elevation AMI. Application of a baseline hs-TnI cutoff concentration of 3 ng/L resulted in a NPV of 99.4%. After additional application of a non-ischaemic ECG, the NPV increased to 100%. This translated into immediate rule-out of 21% of all patients. The mortality rate in this rule-out population was 0% after 12 months. 2 independent cohorts validated the high NPV of this approach (NPV 100% and 99.8%).
Conclusion: Application of a baseline hs-TnI cutoff concentration of 3 ng/L combined with a non-ischaemic ECG excluded AMI safely without need for serial troponin testing.
- Acute coronary syndromes
- Myocardial infarction, NSTEMI
- Chest pain centers
- Myocardial infarction
Author Disclosures: J.T. Neumann: None. N.A. Sörensen: None. F. Ojeda: None. T. Schwemer: None. T. Keller: None. T. Renne: None. U. Landmesser: Honoraria; Modest; Amgen, Sanofi, MSD, Pfizer, Medicines Company. Consultant/Advisory Board; Modest; Amgen, Sanofi, Pfizer, MSD, Medicines Company. P. Clemmensen: None. R. Schnabel: None. T. Zeller: None. M. Karakas: None. M. Than: None. W. Parsonage: None. J. Greenslade: None. L. Cullen: Honoraria; Modest; Abbott Diagnostics, Siemens, Radiometer Pacific, Alere, Roche Diagnostics. S. Blankenberg: Honoraria; Modest; Abbott Diagnostics, Siemens, Thermo Fisher, Roche Diagnostics. Consultant/Advisory Board; Modest; Thermo Fisher. D. Westermann: None.
- © 2016 by American Heart Association, Inc.