Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events. Mokhtari, A., Lindahl, B., Smith, J. G., Holzmann, M. J., Khoshnood, A., & Ekelund, U. Annals of Emergency Medicine, 68(6):649–658.e3, December, 2016. Paper doi abstract bibtex Methods: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians’ assessments of patient history and ECG were collected. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause. Results: A total of 1,138 patients were included in the final analysis. The combination of hs-cTnT less than 5 ng/L, a nonischemic ECG result, and a nonhigh risk history was present for 29.2% of all patients and had a sensitivity of 99.2% (95% confidence interval [CI] 95.6% to 100%), negative predictive value (NPV) of 99.7% (95% CI 98.3% to 100%), and a negative likelihood ratio of 0.02 (95% CI 0 to 0.17) for 30-day major adverse cardiac events. The same combination with hs-cTnT less than or equal to 14 ng/L was present in 66.7% of the patients and had a sensitivity of 92% (95% CI 85.8% to 96.1%), NPV of 98.7% (95% CI 97.6% to 99.4%), and negative likelihood ratio of 0.11 (95% CI 0.06 to 0.20). Conclusion: A single hs-cTnT result of less than 5 ng/L at ED presentation when combined with a nonischemic ECG result and a nonhigh risk history identified 29% of chest pain patients at a very low risk of 30-day major adverse cardiac events. A similar strategy with hs-cTnT less than or equal to 14 ng/L was associated with a higher miss rate. [Ann Emerg Med. 2016;68:649-658.]
@article{mokhtari_diagnostic_2016,
title = {Diagnostic {Accuracy} of {High}-{Sensitivity} {Cardiac} {Troponin} {T} at {Presentation} {Combined} {With} {History} and {ECG} for {Ruling} {Out} {Major} {Adverse} {Cardiac} {Events}},
volume = {68},
issn = {01960644},
url = {http://linkinghub.elsevier.com/retrieve/pii/S0196064416302633},
doi = {10.1016/j.annemergmed.2016.06.008},
abstract = {Methods: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians’ assessments of patient history and ECG were collected. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause.
Results: A total of 1,138 patients were included in the final analysis. The combination of hs-cTnT less than 5 ng/L, a nonischemic ECG result, and a nonhigh risk history was present for 29.2\% of all patients and had a sensitivity of 99.2\% (95\% confidence interval [CI] 95.6\% to 100\%), negative predictive value (NPV) of 99.7\% (95\% CI 98.3\% to 100\%), and a negative likelihood ratio of 0.02 (95\% CI 0 to 0.17) for 30-day major adverse cardiac events. The same combination with hs-cTnT less than or equal to 14 ng/L was present in 66.7\% of the patients and had a sensitivity of 92\% (95\% CI 85.8\% to 96.1\%), NPV of 98.7\% (95\% CI 97.6\% to 99.4\%), and negative likelihood ratio of 0.11 (95\% CI 0.06 to 0.20).
Conclusion: A single hs-cTnT result of less than 5 ng/L at ED presentation when combined with a nonischemic ECG result and a nonhigh risk history identified 29\% of chest pain patients at a very low risk of 30-day major adverse cardiac events. A similar strategy with hs-cTnT less than or equal to 14 ng/L was associated with a higher miss rate. [Ann Emerg Med. 2016;68:649-658.]},
language = {en},
number = {6},
urldate = {2018-03-17TZ},
journal = {Annals of Emergency Medicine},
author = {Mokhtari, Arash and Lindahl, Bertil and Smith, J. Gustav and Holzmann, Martin J. and Khoshnood, Ardavan and Ekelund, Ulf},
month = dec,
year = {2016},
keywords = {\_tablet},
pages = {649--658.e3}
}
Downloads: 0
{"_id":"yaxQfKz8hhxTPtXzw","bibbaseid":"mokhtari-lindahl-smith-holzmann-khoshnood-ekelund-diagnosticaccuracyofhighsensitivitycardiactroponintatpresentationcombinedwithhistoryandecgforrulingoutmajoradversecardiacevents-2016","downloads":0,"creationDate":"2019-01-13T08:37:46.722Z","title":"Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events","author_short":["Mokhtari, A.","Lindahl, B.","Smith, J. G.","Holzmann, M. J.","Khoshnood, A.","Ekelund, U."],"year":2016,"bibtype":"article","biburl":"https://bibbase.org/zotero/Rory.miller","bibdata":{"bibtype":"article","type":"article","title":"Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events","volume":"68","issn":"01960644","url":"http://linkinghub.elsevier.com/retrieve/pii/S0196064416302633","doi":"10.1016/j.annemergmed.2016.06.008","abstract":"Methods: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians’ assessments of patient history and ECG were collected. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause. Results: A total of 1,138 patients were included in the final analysis. The combination of hs-cTnT less than 5 ng/L, a nonischemic ECG result, and a nonhigh risk history was present for 29.2% of all patients and had a sensitivity of 99.2% (95% confidence interval [CI] 95.6% to 100%), negative predictive value (NPV) of 99.7% (95% CI 98.3% to 100%), and a negative likelihood ratio of 0.02 (95% CI 0 to 0.17) for 30-day major adverse cardiac events. The same combination with hs-cTnT less than or equal to 14 ng/L was present in 66.7% of the patients and had a sensitivity of 92% (95% CI 85.8% to 96.1%), NPV of 98.7% (95% CI 97.6% to 99.4%), and negative likelihood ratio of 0.11 (95% CI 0.06 to 0.20). Conclusion: A single hs-cTnT result of less than 5 ng/L at ED presentation when combined with a nonischemic ECG result and a nonhigh risk history identified 29% of chest pain patients at a very low risk of 30-day major adverse cardiac events. A similar strategy with hs-cTnT less than or equal to 14 ng/L was associated with a higher miss rate. [Ann Emerg Med. 2016;68:649-658.]","language":"en","number":"6","urldate":"2018-03-17TZ","journal":"Annals of Emergency Medicine","author":[{"propositions":[],"lastnames":["Mokhtari"],"firstnames":["Arash"],"suffixes":[]},{"propositions":[],"lastnames":["Lindahl"],"firstnames":["Bertil"],"suffixes":[]},{"propositions":[],"lastnames":["Smith"],"firstnames":["J.","Gustav"],"suffixes":[]},{"propositions":[],"lastnames":["Holzmann"],"firstnames":["Martin","J."],"suffixes":[]},{"propositions":[],"lastnames":["Khoshnood"],"firstnames":["Ardavan"],"suffixes":[]},{"propositions":[],"lastnames":["Ekelund"],"firstnames":["Ulf"],"suffixes":[]}],"month":"December","year":"2016","keywords":"_tablet","pages":"649–658.e3","bibtex":"@article{mokhtari_diagnostic_2016,\n\ttitle = {Diagnostic {Accuracy} of {High}-{Sensitivity} {Cardiac} {Troponin} {T} at {Presentation} {Combined} {With} {History} and {ECG} for {Ruling} {Out} {Major} {Adverse} {Cardiac} {Events}},\n\tvolume = {68},\n\tissn = {01960644},\n\turl = {http://linkinghub.elsevier.com/retrieve/pii/S0196064416302633},\n\tdoi = {10.1016/j.annemergmed.2016.06.008},\n\tabstract = {Methods: This prospective observational study enrolled consecutive ED chest pain patients. Emergency physicians’ assessments of patient history and ECG were collected. The primary outcome was 30-day major adverse cardiac events, defined as acute myocardial infarction, unstable angina, cardiogenic shock, ventricular arrhythmia, atrioventricular block, cardiac arrest, or death of cardiac or unknown cause.\nResults: A total of 1,138 patients were included in the final analysis. The combination of hs-cTnT less than 5 ng/L, a nonischemic ECG result, and a nonhigh risk history was present for 29.2\\% of all patients and had a sensitivity of 99.2\\% (95\\% confidence interval [CI] 95.6\\% to 100\\%), negative predictive value (NPV) of 99.7\\% (95\\% CI 98.3\\% to 100\\%), and a negative likelihood ratio of 0.02 (95\\% CI 0 to 0.17) for 30-day major adverse cardiac events. The same combination with hs-cTnT less than or equal to 14 ng/L was present in 66.7\\% of the patients and had a sensitivity of 92\\% (95\\% CI 85.8\\% to 96.1\\%), NPV of 98.7\\% (95\\% CI 97.6\\% to 99.4\\%), and negative likelihood ratio of 0.11 (95\\% CI 0.06 to 0.20).\nConclusion: A single hs-cTnT result of less than 5 ng/L at ED presentation when combined with a nonischemic ECG result and a nonhigh risk history identified 29\\% of chest pain patients at a very low risk of 30-day major adverse cardiac events. A similar strategy with hs-cTnT less than or equal to 14 ng/L was associated with a higher miss rate. [Ann Emerg Med. 2016;68:649-658.]},\n\tlanguage = {en},\n\tnumber = {6},\n\turldate = {2018-03-17TZ},\n\tjournal = {Annals of Emergency Medicine},\n\tauthor = {Mokhtari, Arash and Lindahl, Bertil and Smith, J. Gustav and Holzmann, Martin J. and Khoshnood, Ardavan and Ekelund, Ulf},\n\tmonth = dec,\n\tyear = {2016},\n\tkeywords = {\\_tablet},\n\tpages = {649--658.e3}\n}\n\n","author_short":["Mokhtari, A.","Lindahl, B.","Smith, J. G.","Holzmann, M. J.","Khoshnood, A.","Ekelund, U."],"key":"mokhtari_diagnostic_2016","id":"mokhtari_diagnostic_2016","bibbaseid":"mokhtari-lindahl-smith-holzmann-khoshnood-ekelund-diagnosticaccuracyofhighsensitivitycardiactroponintatpresentationcombinedwithhistoryandecgforrulingoutmajoradversecardiacevents-2016","role":"author","urls":{"Paper":"http://linkinghub.elsevier.com/retrieve/pii/S0196064416302633"},"keyword":["_tablet"],"downloads":0},"search_terms":["diagnostic","accuracy","high","sensitivity","cardiac","troponin","presentation","combined","history","ecg","ruling","out","major","adverse","cardiac","events","mokhtari","lindahl","smith","holzmann","khoshnood","ekelund"],"keywords":["_tablet"],"authorIDs":[],"dataSources":["ehmLBKMxLmAEHFGjZ"]}