Clinical biochemistry
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Clinical biochemistry · Mar 2015
An approach to rule-out an acute cardiovascular event or death in emergency department patients using outcome-based cutoffs for high-sensitivity cardiac troponin assays and glucose.
The application of "undetectable" high-sensitivity cardiac troponin (hs-cTn) concentrations to "rule-out" myocardial infarction is appealing, but there are analytical concerns and a lack of consensus on what concentration should be used to define the lower reportable limit; i.e., limit of detection (LoD) or limit of blank. An alternative approach is to utilize a measurable hs-cTn concentration that identifies patients at low-risk for a future cardiovascular event combined with another prognostic test, such as glucose. We assessed both of these approaches in different emergency department (ED) cohorts to rule-out an event. ⋯ The combination of a "healthy" hs-cTn concentration with glucose might effectively rule-out patients for an acute cardiovascular event at ED presentation.
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Clinical biochemistry · Mar 2015
Multicenter StudyDiagnostic performance of cardiac Troponin I for early rule-in and rule-out of acute myocardial infarction: Results of a prospective multicenter trial.
To compare emergency department TnI serial sampling intervals, determine optimal diagnostic thresholds, and report representative diagnostic performance characteristics for early rule-in and rule-out of MI. ⋯ We report a large multicenter prospective adjudicated trial assessing troponin for early rule-in and rule-out using the Universal Definition of MI and conducted in primary care hospital-associated emergency departments. Our study demonstrates high diagnostic accuracy at early observation times, and reinforces consensus recommendations for sampling on admission and 3h later, repeated at 6h when clinical suspicion remains high.
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Clinical biochemistry · Mar 2015
ReviewHow acute changes in cardiac troponin concentrations help to handle the challenges posed by troponin elevations in non-ACS-patients.
Cardiac troponins (cTn) I and T are organ-specific, but not disease specific biomarkers. Although acute myocardial infarction (AMI) is the most important cause of cTn elevation, other cardiac disorders as well as primarily noncardiac disorders with cardiac involvement often are also associated with cardiomyocyte injury. Levels of cTn should be interpreted as quantitative markers of cardiomyocyte injury with the likelihood of AMI increasing with the level of cTn. ⋯ Two caveats apply to the diagnostic use of cTn changes. First, patients with AMI may show no or only a minimal change when assessed around the peak of cTn release. Second, in addition to AMI, several other acute cardiac conditions including tachyarrhythmias, myocarditis, hypertensive crisis, and Takotsubo cardiomyopathy also may present with substantial cTn changes.
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Clinical biochemistry · Mar 2015
ReviewEffectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review.
This article is a systematic review of the effectiveness of four practices (assay selection, decision point cardiac troponin (cTn) threshold selection, serial testing, and point of care testing) for improving the diagnostic accuracy Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) in the Emergency Department. ⋯ The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR).
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Clinical biochemistry · Mar 2015
Multicenter Study Observational StudyCombining 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.
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). ⋯ 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.