Measurement of cardiac troponin T is an effective method for predicting complications among emergency department patients with chest pain

M. R. Sayre, K. H. Kaufmann, I. W. Chen, M. Sperling, R. D. Sidman, D. B. Diercks, T. Liu, W. B. Gibler

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Study Objectives: To determine the test performance characteristics of serum cardiac troponin T (cTnT) measurement for diagnosis of acute myocardial infarction (AMI), and to determine the ability of cTnT to stratify emergency department patients with chest pain into high- and low-risk groups for cardiac complications. Methods: We conducted a prospective observational cohort study with convenience sampling in a tertiary care, urban ED. The study sample comprised 667 patients presenting to the ED with a complaint of chest pain or other symptoms suggesting acute ischemic coronary syndrome (AICS). Patients were assigned to different blood sampling protocols for cTnT therapy on the basis of their ECG at presentation: nondiagnostic for AMI at 0, 3, 6, 9, 12, and 24 hours after ED presentation; or ECG diagnostic for AMI at 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 12, 18, and 24 hours after ED presentation. Results: Of 667 patients, 34 had AMI diagnosed within 24 hours of ED arrival. Using a .2 μg/L discrimination level for cTnT, sensitivity for AMI within 24 hours of ED arrival was 97% (95% confidence interval, 91.4% to 99.9%), and specificity was 92% (89.8%-94.1%). When the effects of age, race, sex, and creatine kinase-MB isoenzyme subunit test results were controlled, a patient with cTnT of .2 μg/L or greater was 3.5 (1.4 to 9.1) times more likely to have a cardiac complication within 60 days of ED arrival than a patient with a cTnT value below .2 mg/L. Conclusion: Measurement of cTnT will accurately identify myocardial necrosis in patients presenting to the ED with possible AICS. Elevated cTnT values identify patients at increased risk of cardiac complications.

Original languageEnglish (US)
Pages (from-to)539-549
Number of pages11
JournalAnnals of Emergency Medicine
Volume31
Issue number5
DOIs
StatePublished - 1998
Externally publishedYes

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Troponin T
Chest Pain
Hospital Emergency Service
Myocardial Infarction
Acute Coronary Syndrome
Electrocardiography
MB Form Creatine Kinase
Tertiary Healthcare
Isoenzymes
Observational Studies
Cohort Studies
Necrosis
Confidence Intervals
Serum

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Measurement of cardiac troponin T is an effective method for predicting complications among emergency department patients with chest pain. / Sayre, M. R.; Kaufmann, K. H.; Chen, I. W.; Sperling, M.; Sidman, R. D.; Diercks, D. B.; Liu, T.; Gibler, W. B.

In: Annals of Emergency Medicine, Vol. 31, No. 5, 1998, p. 539-549.

Research output: Contribution to journalArticle

Sayre, M. R. ; Kaufmann, K. H. ; Chen, I. W. ; Sperling, M. ; Sidman, R. D. ; Diercks, D. B. ; Liu, T. ; Gibler, W. B. / Measurement of cardiac troponin T is an effective method for predicting complications among emergency department patients with chest pain. In: Annals of Emergency Medicine. 1998 ; Vol. 31, No. 5. pp. 539-549.
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abstract = "Study Objectives: To determine the test performance characteristics of serum cardiac troponin T (cTnT) measurement for diagnosis of acute myocardial infarction (AMI), and to determine the ability of cTnT to stratify emergency department patients with chest pain into high- and low-risk groups for cardiac complications. Methods: We conducted a prospective observational cohort study with convenience sampling in a tertiary care, urban ED. The study sample comprised 667 patients presenting to the ED with a complaint of chest pain or other symptoms suggesting acute ischemic coronary syndrome (AICS). Patients were assigned to different blood sampling protocols for cTnT therapy on the basis of their ECG at presentation: nondiagnostic for AMI at 0, 3, 6, 9, 12, and 24 hours after ED presentation; or ECG diagnostic for AMI at 0, 1, 2, 3, 4, 5, 6, 7, 8, 9, 12, 18, and 24 hours after ED presentation. Results: Of 667 patients, 34 had AMI diagnosed within 24 hours of ED arrival. Using a .2 μg/L discrimination level for cTnT, sensitivity for AMI within 24 hours of ED arrival was 97{\%} (95{\%} confidence interval, 91.4{\%} to 99.9{\%}), and specificity was 92{\%} (89.8{\%}-94.1{\%}). When the effects of age, race, sex, and creatine kinase-MB isoenzyme subunit test results were controlled, a patient with cTnT of .2 μg/L or greater was 3.5 (1.4 to 9.1) times more likely to have a cardiac complication within 60 days of ED arrival than a patient with a cTnT value below .2 mg/L. Conclusion: Measurement of cTnT will accurately identify myocardial necrosis in patients presenting to the ED with possible AICS. Elevated cTnT values identify patients at increased risk of cardiac complications.",
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AU - Kaufmann, K. H.

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AU - Sidman, R. D.

AU - Diercks, D. B.

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