AI Article Synopsis
- The hs-TnT assay is effective in helping doctors make decisions for low-risk patients with chest pain, though its reliability in this specific group has not been thoroughly documented.
- In a study involving 48 patients, the hs-TnT levels were measured at three different times to evaluate their ability to predict myocardial ischaemia detected by PET-CT.
- Results showed a strong negative predictive value (94% at T0, 100% at T2, and 100% at T6), indicating that low hs-TnT levels (<4 ng/L) can confidently rule out significant ischaemia, despite lower accuracy in identifying positive cases.
Article Abstract
Background: Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented.
Purpose: To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain.
Methods: Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled. Their hs-TnT samples were at T0, T2 and T6. Physicians were blinded to hs-TnT results. All patients underwent a PET-CT at rest and during adenosine-induced stress. All patients with a positive PET-CT result underwent a coronary angiography.
Results: Forty-eight patients were included. Six had ischaemia at PET-CT. All of them had ≥1 significant stenosis at coronary angiography. Areas under the curve (95% CI) for predicting significant ischaemia at PET-CT using hs-TnT were 0.764 (0.515 to 1.000) at T0, 0.812(0.616 to 1.000) at T2 and 0.813(0.638 to 0.989) at T6. The receiver operating characteristicbased optimal cut-off value for hs-TnT at T0, T2 and T6 needed to exclude significant ischaemia at PET-CT was <4 ng/L. Using this value, sensitivity, specificity, positive and negative predictive values of hs-TnT to predict significant ischaemia were 83%/38%/16%/94% at T0, 100%/40%/19%/100% at T2 and 100%/43%/20%/100% at T6, respectively.
Conclusions: Our findings suggest that in low-risk patients, using the hs-TnT assay with a cut-off value of 4 ng/L demonstrates excellent negative predictive value to exclude myocardial ischaemia detection at PET-CT, at the expense of weak specificity and positive predictive value.
Trial Registration Number: ClinicalTrials.gov Identifier: NCT01374607.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734281 | PMC |
| http://dx.doi.org/10.1136/bmjopen-2016-014655 | DOI Listing |
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