Clinical Research
Biomarkers
Undetectable High-Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction

https://doi.org/10.1016/j.jacc.2014.03.017Get rights and content
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Objectives

This study sought to evaluate if an undetectable (<5 ng/l) high-sensitivity cardiac troponin T (hs-cTnT) level and an electrocardiogram (ECG) without signs of ischemia can rule out myocardial infarction (MI) in the emergency department (ED).

Background

Chest pain is a common symptom often associated with benign conditions, but may be a sign of MI. Because there is no rapid way to rule out MI, many patients are admitted to the hospital.

Methods

All patients who sought medical attention for chest pain and had at least 1 hs-cTnT analyzed during 2 years at the Karolinska University Hospital, Stockholm, Sweden, were included. We calculated the negative predictive values of an undetectable hs-cTnT and ECG without ischemia for MI and death within 30 days.

Results

We included 14,636 patients, of whom 8,907 (61%) had an initial hs-cTnT of <5 ng/l; 21% had 5 to 14 ng/l, and 18% had >14 ng/l. During 30-day follow-up, 39 (0.44%) patients with undetectable hs-cTnT had a MI, of whom 15 (0.17%) had no ischemic ECG changes. The negative predictive value for MI within 30 days in patients with undetectable hs-cTnT and no ischemic ECG changes was 99.8% (95% confidence interval [CI]: 99.7 to 99.9). The negative predictive value for death was 100% (95% CI: 99.9 to 100).

Conclusions

All patients with chest pain who have an initial hs-cTnT level of <5 ng/l and no signs of ischemia on an ECG have a minimal risk of MI or death within 30 days, and can be safely discharged directly from the ED.

Key Words

chest pain
emergency department
high-sensitivity troponin
myocardial infarction

Abbreviations and Acronyms

CI
confidence interval
ECG
electrocardiogram
ED
emergency department
eGFR
estimated glomerular filtration rate
hs-cTnT
high-sensitivity cardiac troponin T
MI
myocardial infarction
NSTEMI
non–ST-segment elevation myocardial infarction
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

The authors have reported that they have no relevant relationships to the contents of this paper to disclose.