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.
Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events [link]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}
}
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