AI Article Synopsis
- Elevated cardiac troponin I (cTnI) levels can indicate acute coronary syndrome (ACS), but they can also arise from non-ACS conditions.
- This study aimed to establish simple clinical criteria that could effectively rule out ACS in hospitalized patients with elevated cTnI levels.
- The findings showed that patients with peak cTnI levels under 2 ng/dL, no history of coronary artery disease, and no wall-motion abnormalities on echocardiograms had a very low probability of having ACS, suggesting that further diagnostic testing might be unnecessary for these individuals.
Article Abstract
Background: Elevated cardiac troponin I (cTnI) occurs in acute coronary syndrome (ACS) as well as various scenarios not associated with ACS.
Hypothesis: Simple clinical criteria can reliably exclude ACS among hospitalized patients with elevated cTnI.
Methods: Records for patients hospitalized from January to April 2011 with elevated cTnI (>0.29 ng/dL) and an available echocardiogram were retrospectively reviewed. Patients with ST-segment elevation myocardial infarction were excluded. Based on available clinical data, patients were classified as having ACS or elevation of cTnI unrelated to ACS (non-ACS). Median follow-up was 365 days.
Results: Of 265 records meeting inclusion criteria, 82 (31%) had ACS and 183 (69%) had non-ACS. In multivariable analysis, odds ratios for non-ACS were 7.6 (95% confidence interval [CI]: 3.8-15.3) for peak cTnI <2 ng/dL, 6.3 (95% CI: 3.1-13.0) for absent wall-motion abnormality, and 4.4 (95% CI: 2.2-8.6) for no prior coronary artery disease history. The area under the receiver operating curve for amodel using these 3 variables was 0.86, with a 98% negative predictive value for excluding ACS. Patients who met these 3 criteria had no ACS-related deaths over 1-year follow-up.
Conclusions: Hospitalized patients with peak Tn level<2 ng/dL, no prior history of coronary artery disease, and no new echocardiographic wall-motion abnormality appear to have a very low likelihood of ACS. Prospective validation of these results is needed to determine whether additional diagnostic testing could be safely avoided in hospitalized patients meeting these simple clinical criteria.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649370 | PMC |
| http://dx.doi.org/10.1002/clc.22263 | DOI Listing |
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