PMID- 25485933
OWN - NLM
STAT- MEDLINE
DCOM- 20160104
LR  - 20150317
IS  - 1873-2933 (Electronic)
IS  - 0009-9120 (Linking)
VI  - 48
IP  - 4-5
DP  - 2015 Mar
TI  - Combining presentation high-sensitivity cardiac troponin I and glucose 
      measurements to rule-out an acute myocardial infarction in patients presenting to 
      emergency department with chest pain.
PG  - 288-91
LID - S0009-9120(14)00778-4 [pii]
LID - 10.1016/j.clinbiochem.2014.11.019 [doi]
AB  - BACKGROUND AND AIMS: The use of high sensitivity troponin (hs-Tn) may enable 
      early rule out of acute myocardial infarction (AMI) for patients presenting to 
      the emergency department (ED) with chest pain. This study evaluated two 
      approaches to the early rule out of AMI; a combination of a presentation hs-Tn 
      <4ng/L and normal glucose at presentation (dual testing) and a presentation hs-Tn 
      troponin below the limit of detection (LoD). METHODS: We utilised prospectively 
      collected data on adult patients presenting with suspected ACS in two EDs in 
      Australia and New Zealand. Blood samples were taken on presentation and tested 
      for glucose and high sensitivity troponin I. The primary endpoint was index AMI 
      and the secondary endpoint was 30-day acute coronary syndrome (ACS). Sensitivity, 
      specificity, positive and negative predictive values were used to assess the 
      diagnostic accuracy of the dual testing and LoD approaches. RESULTS: Of the 1412 
      participants, 182 (12.9%) had index AMI. The LoD and the dual testing approach 
      were 100% sensitive for index AMI. The specificity of the dual testing approach 
      (25.2%) was slightly higher than that of the LoD (20.4%). Sensitivity for ACS was 
      similar for the two approaches (96.5% for dual testing and 98.1% for the LoD). 
      CONCLUSIONS: The dual testing and LoD approach identified all patients with index 
      AMI and could be used to reduce the proportion of patients requiring lengthy 
      assessment and inpatient admission. Further investigation is still required to 
      rule out unstable angina pectoris in patients identified as low risk.
CI  - Copyright (c) 2014 The Canadian Society of Clinical Chemists. Published by Elsevier 
      Inc. All rights reserved.
FAU - Greenslade, J H
AU  - Greenslade JH
AD  - Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Australia 
      School of Medicine, The University of Queensland, Australia School of Public 
      Health, Queensland University of Technology, Australia. Electronic address: 
      jaimi.greenslade@health.qld.gov.au.
FAU - Kavsak, P
AU  - Kavsak P
AD  - Department of Pathology and Molecular Medicine, McMaster University, Canada.
FAU - Parsonage, W
AU  - Parsonage W
AD  - Department of Cardiology, Royal Brisbane and Women's Hospital, Australia School 
      of Medicine, The University of Queensland, Australia School of Public Health, 
      Queensland University of Technology Australia, Australia.
FAU - Shortt, C
AU  - Shortt C
AD  - Department of Pathology and Molecular Medicine, McMaster University, Canada.
FAU - Than, M
AU  - Than M
AD  - Department of Emergency Medicine, Christchurch Hospital, New Zealand.
FAU - Pickering, J W
AU  - Pickering JW
AD  - Emergency Care Foundation, Christchurch Hospital, New Zealand.
FAU - Aldous, S
AU  - Aldous S
AD  - Department of Cardiology, Christchurch Hospital, New Zealand.
FAU - Cullen, L
AU  - Cullen L
AD  - Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Australia 
      School of Medicine, The University of Queensland, Australia School of Public 
      Health, Queensland University of Technology, Australia.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20141205
PL  - United States
TA  - Clin Biochem
JT  - Clinical biochemistry
JID - 0133660
RN  - 0 (Biomarkers)
RN  - 0 (Troponin I)
RN  - IY9XDZ35W2 (Glucose)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Biological Assay/methods/*standards
MH  - Biomarkers/blood
MH  - Chest Pain/*blood/diagnosis
MH  - Cohort Studies
MH  - Emergency Service, Hospital/*standards
MH  - Female
MH  - Glucose/*metabolism
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*blood/diagnosis
MH  - Prospective Studies
MH  - Troponin I/*blood
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - Acute myocardial infarction
OT  - High sensitivity troponin
EDAT- 2014/12/09 06:00
MHDA- 2016/01/05 06:00
CRDT- 2014/12/09 06:00
PHST- 2014/10/12 00:00 [received]
PHST- 2014/11/24 00:00 [accepted]
PHST- 2014/12/09 06:00 [entrez]
PHST- 2014/12/09 06:00 [pubmed]
PHST- 2016/01/05 06:00 [medline]
AID - S0009-9120(14)00778-4 [pii]
AID - 10.1016/j.clinbiochem.2014.11.019 [doi]
PST - ppublish
SO  - Clin Biochem. 2015 Mar;48(4-5):288-91. doi: 10.1016/j.clinbiochem.2014.11.019. 
      Epub 2014 Dec 5.