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Ability of troponin I to predict cardiac events in patients admitted from the emergency department.

Abstract：

OBJECTIVES:We sought to determine the predictive ability of troponin I (TnI) in a heterogeneous group of patients with chest pain admitted from the emergency department (ED) for exclusion of myocardial infarction (MI). BACKGROUND:Previous studies in high-risk patients demonstrated that troponin elevations are associated with increased cardiac events. Little information is available on its predictive ability in more heterogeneous, lower risk patients. METHODS:Consecutive patients admitted from the ED for possible MI underwent serial myocardial marker sampling of TnI and creatine kinase, CK-MB over an 8-h period. Patients with ST segment elevation were excluded. End points included MI, death, significant complications (e.g., cardiac or respiratory arrest, intra-aortic balloon pump, pulmonary artery catheter or pacemaker placement, revascularization or inotropic infusion) and significant disease. RESULTS:Events occurred in 513 (27%) of the 1,929 patients evaluated: MI in 175 (9.1%) and death in 34 (1.8%); an additional 248 patients (13%) without MI had complications, and 323 (17%) without MI had significant disease. Sensitivity of TnI for MI was high (96%). Patients without MI who were TnI-positive were more likely to have complications (43% vs. 12%) or significant disease (41% vs. 17%) as compared with those who were TnI-negative; however, the sensitivity of TnI for these two end points was low (14% and 21%, respectively). Predictive values were unchanged after excluding patients with ischemic electrocardiograms. CONCLUSIONS:Troponin I had a high sensitivity for MI when used as part of a rapid rule-in protocol; however, the sensitivity for other end points was low. Use of TnI alone failed to identify the majority of patients who had either significant disease or complications.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kontos MC,Anderson FP,Alimard R,Ornato JP,Tatum JL,Jesse RL

doi

10.1016/s0735-1097(00)00943-8

subject

Has Abstract

pub_date

2000-11-15 00:00:00

pages

1818-23

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(00)00943-8

journal_volume

pub_type

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Ability of troponin I to predict cardiac events in patients admitted from the emergency department.