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CHEST PAIN AND SINGLE TROPONIN

Year 2020, Volume: 10 Issue: 4, 562 - 566, 30.12.2020
https://doi.org/10.16899/jcm.790433

Abstract

Aim: It is important to exclude the diagnosis of acute coronary syndrome quickly and accurately. This study aims to exclude the diagnosis of acute myocardial infarction (AMI) with a single troponin value in patients with appropriate clinical evaluation and electrocardiography (ECG)
Materials and Methods: Among the patients who were followed up with a pre-diagnosis of AMI and for whom a HEART score was calculated, patients whose high sensitive troponin I result was found below the limit of detection (LoD) value and who were discharged is included in study. All patients were contacted on the 30th day of discharge. The status of "major adverse cardiac events" (MACE-30) in the last 30 days was questioned.
Results: The HEART score of 122 patients (73.1%) in the study was found to be at low risk while 45 (26.9%) as moderate. MACE-30 developed in only 5 patients (3%). Of the 5 patients who developed Mace; The HEART score of 3 (60%) was determined as 5, whereas the heart score of 2 (40%) was 6. p <0.001. It was observed that no mace was detected in any patient with a low risk HEART score (p <0.001). The cut off value for the heart score was found to be ≤4 (p<0,001) while the cut off value for age was found to be ≤69 (p<0,001).
Conclusion: We think that patients presenting to the emergency with chest pain, a troponin value below LoD and a low HEART score can be discharged from the emergency department with a single troponin.

References

  • 1) Datlow Mitchell D. et al. Troponin limit of detection plus cardiac risk stratification scores to rule out acute myocardial infarction and 30-day major adverse cardiac events in ED patients. Critical pathways in cardiology 2017; 16.4: 142.
  • 2) Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008; 16:191-6. [PMID: 18665203]
  • 3) Hess EP, Brison RJ, Perry JJ, Calder LA, Thiruganasambandamoorthy V, Agarwal D et al. Development of a clinical prediction rule for 30-day cardiac events in emergency department patients with chest pain and possible acute coronary syndrome. Ann Emerg Med 2012; 59:115-25. [PMID: 21885156] doi:10.1016/j .annemergmed.2011.07.026
  • 4) Than M, Flaws D, Sanders S, Doust J, Glasziou P, Kline J et al. Development and validation of the Emergency Department Assessment of Chest Pain Score and 2 h accelerated diagnostic protocol. Emerg Med Australas 2014; 26:34-44. [PMID: 24428678] doi:10.1111/1742-6723.12164
  • 5) Pickering John W. et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Annals of internal medicine 2017; 166.10: 715-724.
  • 6) Body, Richard, and Charles Reynard. "One shot to rule out: does the limit of detection of a high-sensitivity troponin assay hit the mark?." (2017): 21-23.
  • 7) Body R, Carley S, McDowell G, Jaffe AS, France M, Cruickshank K et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a highsensitivity assay. J Am Coll Cardiol 2011; 58:1332–9.
  • 8) Bandstein N, Ljung R, Johansson M, Holzmann MJ. Undetectable high sensitivity troponin T level in the Emergency Department and risk of myocardial infarction. J Am Coll Cardiol 2014; 63:2569 –78.
  • 9) Body R, Burrows G, Carley S, Cullen L, Than M, Jaffe AS et al. High-sensitivity cardiac troponin t concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation. Clin Chem 2015; 61:983–9.
  • 10) Body R, Carley SD, Burrows G, Mackway-Jones K. The Manchester Acute Coronary Syndromes (MACS) decision rule to reduce unnecessary admissions for cardiac chest pain: derivation and external validation. Acad Emerg Med 2012; 19:744.
  • 11) Cullen L, Than M, Peacock WF. Undetectable hs-cTnT in the emergency department and risk of myocardial infarction. J Am Coll Cardiol 2014; 64:632-3. [PMID: 25104539] doi:10.1016/j.jacc.2014.04.061
  • 12) Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, Bernard R Chaitman, Jeroen J Bax, David A Morrow ET AL. ESC Scientific Document Group, Fourth universal definition of myocardial infarction (2018). European Heart Journal 2019; 40(3):237-269 https://doi.org/10.1093/eurheartj/ehy462
  • 13) Falvo T, Grove L, Stachura R et al. The opportunity loss of boarding admitted patients in the emergency department. Acad Emerg Med 2007; 14:332–7. [PubMed: 17331916]
  • 14) Gomez MA, Anderson JL, Karagounis LA, Muhlestein JB, Mooers FB. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol 1996; 28:25–33. [PubMed: 8752791]
  • 15) Shortt C, Ma J, Clayton N, Sherbino J, Whitlock R, Pare G et al. Rule-in and rule-out of myocardial infarction using cardiac troponin and glycemic biomarkers in patients with symptoms suggestive of acute coronary syndrome. Clin Chem 2017; 63:403–14.
  • 16) Shah ASV, Anand A, Sandoval Y, Lee KK, Smith SW, Adamson PD et al. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet 2015; 386:2481– 8.
  • 17) Neumann JT, Sorensen NA, Ojeda F, Schwemer T, Lehmacher J, Gonner S et al. Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I. Clin Chem 2017;63:394 – 402.
  • 18) Anderson JL, Adams CD, Antman EM et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61: e179–347. [PubMed: 23639841]
  • 19) Backus BE, Six AJ, Kelder JC et al. Chest pain in the emergency room: a multicenter validation of the HEART Score. Crit Pathw Cardiol 2010;9(3):164-169. doi:10.1097/HPC.0b013e3181ec36d8
  • 20) Backus BE, Six AJ, Kelder JC et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013;168(3):2153-2158. doi:10.1016/j.ijcard.2013.01.255

GÖĞÜS AĞRISI VE TEK TROPONİN

Year 2020, Volume: 10 Issue: 4, 562 - 566, 30.12.2020
https://doi.org/10.16899/jcm.790433

Abstract

Amaç: Akut koroner sendrom tanısını hızlı ve doğru şekilde dışlamak önemlidir. Çalışmanın amacı, klinik değerlendirme ve elektrokardiyogarfisi (EKG) uygun hastalarda, tek troponin değeri ile akut miyokard enfarktus (AMI) tanısını dışlamaktır.
Gereç ve Yöntem: Acil serviste AMI ön tanısı ile izlenen ve HEART score hesaplanan hastalar arasından; high sensitive troponin I sonucu limit of detection (LoD) değeri altında saptanan ve taburcu edilen hastalar çalışmaya alındı. Tüm hastalar taburculuğun 30. gününde telefon ile arandı. Son 30 gün içinde “major adverse cardiac events” (MACE-30) durumları sorgulandı.
Bulgular: Çalışmadaki 122 hastanın (73.1%) HEART score low risk, 45 hastanın (26.9%) HEART score moderate risk olarak bulundu. MACE-30 sadece 5 hastada (3%) gelişmiştir. Mace gelişen toplam 5 hastadan; 3 ünün (60%) HEART score 5, 2 sinin (40%) heart skoru 6 olarak saptandı. p<0,001. HEART score low risk olan hiçbir hastada mace saptanmadığı görüldü. (p<0,001). Heart skoruna yönelik cut off değeri ≤4 olarak bulundu. (p<0,001). Yaş için cut off değeri ≤69 bulunmuştur. (p<0,001).
Sonuç: Göğüs ağrısı ile acil servise başvuran, troponin LoD değerinin altında olan ve düşük HEART skorlu hastaların acil servisten tek troponin ile taburcu edilebileceğini düşünüyoruz.

References

  • 1) Datlow Mitchell D. et al. Troponin limit of detection plus cardiac risk stratification scores to rule out acute myocardial infarction and 30-day major adverse cardiac events in ED patients. Critical pathways in cardiology 2017; 16.4: 142.
  • 2) Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J 2008; 16:191-6. [PMID: 18665203]
  • 3) Hess EP, Brison RJ, Perry JJ, Calder LA, Thiruganasambandamoorthy V, Agarwal D et al. Development of a clinical prediction rule for 30-day cardiac events in emergency department patients with chest pain and possible acute coronary syndrome. Ann Emerg Med 2012; 59:115-25. [PMID: 21885156] doi:10.1016/j .annemergmed.2011.07.026
  • 4) Than M, Flaws D, Sanders S, Doust J, Glasziou P, Kline J et al. Development and validation of the Emergency Department Assessment of Chest Pain Score and 2 h accelerated diagnostic protocol. Emerg Med Australas 2014; 26:34-44. [PMID: 24428678] doi:10.1111/1742-6723.12164
  • 5) Pickering John W. et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Annals of internal medicine 2017; 166.10: 715-724.
  • 6) Body, Richard, and Charles Reynard. "One shot to rule out: does the limit of detection of a high-sensitivity troponin assay hit the mark?." (2017): 21-23.
  • 7) Body R, Carley S, McDowell G, Jaffe AS, France M, Cruickshank K et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a highsensitivity assay. J Am Coll Cardiol 2011; 58:1332–9.
  • 8) Bandstein N, Ljung R, Johansson M, Holzmann MJ. Undetectable high sensitivity troponin T level in the Emergency Department and risk of myocardial infarction. J Am Coll Cardiol 2014; 63:2569 –78.
  • 9) Body R, Burrows G, Carley S, Cullen L, Than M, Jaffe AS et al. High-sensitivity cardiac troponin t concentrations below the limit of detection to exclude acute myocardial infarction: a prospective evaluation. Clin Chem 2015; 61:983–9.
  • 10) Body R, Carley SD, Burrows G, Mackway-Jones K. The Manchester Acute Coronary Syndromes (MACS) decision rule to reduce unnecessary admissions for cardiac chest pain: derivation and external validation. Acad Emerg Med 2012; 19:744.
  • 11) Cullen L, Than M, Peacock WF. Undetectable hs-cTnT in the emergency department and risk of myocardial infarction. J Am Coll Cardiol 2014; 64:632-3. [PMID: 25104539] doi:10.1016/j.jacc.2014.04.061
  • 12) Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, Bernard R Chaitman, Jeroen J Bax, David A Morrow ET AL. ESC Scientific Document Group, Fourth universal definition of myocardial infarction (2018). European Heart Journal 2019; 40(3):237-269 https://doi.org/10.1093/eurheartj/ehy462
  • 13) Falvo T, Grove L, Stachura R et al. The opportunity loss of boarding admitted patients in the emergency department. Acad Emerg Med 2007; 14:332–7. [PubMed: 17331916]
  • 14) Gomez MA, Anderson JL, Karagounis LA, Muhlestein JB, Mooers FB. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol 1996; 28:25–33. [PubMed: 8752791]
  • 15) Shortt C, Ma J, Clayton N, Sherbino J, Whitlock R, Pare G et al. Rule-in and rule-out of myocardial infarction using cardiac troponin and glycemic biomarkers in patients with symptoms suggestive of acute coronary syndrome. Clin Chem 2017; 63:403–14.
  • 16) Shah ASV, Anand A, Sandoval Y, Lee KK, Smith SW, Adamson PD et al. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet 2015; 386:2481– 8.
  • 17) Neumann JT, Sorensen NA, Ojeda F, Schwemer T, Lehmacher J, Gonner S et al. Immediate rule-out of acute myocardial infarction using electrocardiogram and baseline high-sensitivity troponin I. Clin Chem 2017;63:394 – 402.
  • 18) Anderson JL, Adams CD, Antman EM et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61: e179–347. [PubMed: 23639841]
  • 19) Backus BE, Six AJ, Kelder JC et al. Chest pain in the emergency room: a multicenter validation of the HEART Score. Crit Pathw Cardiol 2010;9(3):164-169. doi:10.1097/HPC.0b013e3181ec36d8
  • 20) Backus BE, Six AJ, Kelder JC et al. A prospective validation of the HEART score for chest pain patients at the emergency department. Int J Cardiol 2013;168(3):2153-2158. doi:10.1016/j.ijcard.2013.01.255
There are 20 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Süha Serin 0000-0003-0654-8061

Bahadir Çağlar 0000-0002-4164-393X

Publication Date December 30, 2020
Acceptance Date September 8, 2020
Published in Issue Year 2020 Volume: 10 Issue: 4

Cite

AMA Serin S, Çağlar B. CHEST PAIN AND SINGLE TROPONIN. J Contemp Med. December 2020;10(4):562-566. doi:10.16899/jcm.790433