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Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac troponin T levels at presentation

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Abstract

The reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection in ruling-out short- and long-term acute coronary events in subjects for suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not definitely settled. In a retrospective chart review analysis, 1001 subjects with hs-cTnT ≤ 14 ng/L out of 4053 subjects with hs-cTnT measured at Emergency Department (ED) presentation were recruited. The main outcome measure is fatal or non-fatal myocardial infarction (MI) within 30 days; secondary outcomes are MI or major acute coronary events (MACE) as a combination of MI or re-hospitalization for unstable angina within 1 year. In subjects with hs-cTnT < 5 ng/L [32.6% of cases, mean age 63 years (interquartile range 23)], no cases (0%, NPV 100%) had MI within 30 days, 2 cases (0.6%, NPV 99.4%) MI at 1-year, and 11 cases (3.4%, NPV 96.6%) MACE at 1-year. Patients with hs-cTnT < 5 ng/L would have benefited from a shortened decision (9.30 h and 53% overnight ED stay saved). Hs-cTnT < 5 ng/L is confirmed as safe for patients and comfortable for physicians in ruling out MI or MACE both at short and long term, suggesting that a sizable number of patients can be rapidly discharged without unnecessary diagnostic tests and ED observation.

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Acknowledgements

We are grateful to Daniela Bellavista, Medical Project Manager, Roche Diagnostics Italy for helpful support.

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Authors and Affiliations

  1. Dipartimento Emergenza, Presidio Ospedaliero Morgagni-Pierantoni, Azienda USL della Romagna, Via C Forlanini 34, 47121, Forlì, FC, Italy

    Andrea Fabbri, Alice Morelli, Barbara Benazzi, Sergio Spiezia & Marco Cortigiani

  2. Dipartimento Cardio-vascolare, Presidio Ospedaliero Morgagni-Pierantoni, AUSL della Romagna, Via C Forlanini 34, 47121, Forlì, FC, Italy

    Cristina Bachetti, Filippo Ottani & Marcello Galvani

  3. Laboratorio Unico AUSL della Romagna, Piazzale della Liberazione 60, Pievesestina di Cesena, FC, Italy

    Romolo Dorizzi

  4. Cardiovascular Department and Department of Laboratory Medicine and Pathology, Mayo Clinic and Medical School, 200 First St. SW, Rochester, MN, 55905, USA

    Allan S. Jaffe

  5. Cardiovascular Research Unit, Fondazione Cardiologica Sacco, 47121, Forlì, FC, Italy

    Filippo Ottani & Marcello Galvani

Authors
  1. Andrea Fabbri
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  2. Cristina Bachetti
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  3. Filippo Ottani
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  4. Alice Morelli
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  5. Barbara Benazzi
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  6. Sergio Spiezia
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  7. Marco Cortigiani
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  8. Romolo Dorizzi
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  9. Allan S. Jaffe
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Contributions

AF and MG had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the results. All authors were involved in the study concept and design and statistical analyses. MC, BB, AM, SS and BC were responsible for collection, management, analyses and interpretation of the data. AF and MG conducted the statistical analyses and drafted the manuscript. All authors contributed substantially to its revision and agree to be accountable for all the aspects of the work. FO, ASJ and RD supervised the study. AF takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Andrea Fabbri.

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The authors have no conflicts of interest to disclose.

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The authors declare that all contents in this study are in accordance with ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This is a retrospective study and for this type of study formal consent is not required.

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Fabbri, A., Bachetti, C., Ottani, F. et al. Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac troponin T levels at presentation. Intern Emerg Med 14, 403–410 (2019). https://doi.org/10.1007/s11739-018-1996-6

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  • DOI: https://doi.org/10.1007/s11739-018-1996-6

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