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Can troponin I measurement predict short-term serious cardiac outcomes in patients presenting to the emergency department with possible acute coronary syndrome?

Published online by Cambridge University Press:  21 May 2015

Stephen A. Hill ,
P.J. Devereaux ,
Lauren Griffith ,
John Opie ,
Matthew J. McQueen ,
Akbar Panju ,
Eric Stanton  and
Gordon H. Guyatt
Stephen A. Hill*
Affiliation:
Department Pathology and Molecular Medicine Hamilton Regional Laboratory Medicine Program, Hamilton, Ont
P.J. Devereaux
Affiliation:
Department of Medicine
Lauren Griffith
Affiliation:
Department of Clinical Epidemiology and Biostatistics
John Opie
Affiliation:
Department of Emergency Medicine, McMaster University, Hamilton, Ont
Matthew J. McQueen
Affiliation:
Department Pathology and Molecular Medicine Hamilton Regional Laboratory Medicine Program, Hamilton, Ont
Akbar Panju
Affiliation:
Department of Medicine
Eric Stanton
Affiliation:
Department of Medicine
Gordon H. Guyatt
Affiliation:
Department of Medicine Department of Clinical Epidemiology and Biostatistics
*
Laboratory Medicine, Hamilton General Hospital, 237 Barton St. E, Hamilton ON L8L 2X2; hillstev@hhsc.ca

Abstract

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Objective:

To determine the ability of troponin I (TnI) measurement to predict the likelihood of a serious cardiac outcome over the subsequent 72 hours in patients presenting to the emergency department (ED) with symptoms suggestive of an acute coronary syndrome.

Methods:

This prospective observational study enrolled consecutive patients presenting to 2 urban tertiary care hospital EDs over a 5-week period. Eligible patients included those for whom a TnI test was ordered within 24 hours of arrival and in whom no serious cardiac outcome occurred before the test result was available. Patients were followed for 72 hours and serious cardiac outcomes documented; these included cardiovascular death, myocardial infarction, congestive heart failure, serious arrhythmia and refractory pain. We calculated likelihood ratios (LRs) to describe the association of the TnI result with serious cardiac outcomes.

Results:

Of the 352 enrolled patients, 20 had a serious cardiac outcome within 72 hours of ED presentation. The derived LRs (and 95% confidence interval [CI]) were 0.5 (0.3–0.9) for TnI values <0.5 µg/L, 1.6 (0.4–6.5) for TnI values from 0.5 to 2.0 µg/L, 5.8 (1.7–19.5) for TnI values from >2.0 to 10.0 µg/L and 14.4 (4.8–42.9) for TnI values >10.0 µg/L.

Conclusions:

TnI values >2.0 µg/L are associated with an increased probability of serious cardiac outcomes within 72 hours. TnI values between 0.5 and 2.0 µg/L are weakly positive predictors. TnI values <0.5 µg/L have LRs in the range of 0.5 and thus are weakly negative predictors, not substantially decreasing the likelihood of serious cardiac outcomes, particularly in patients with a moderate or high pretest probability.

Keywords

cardiac troponinacute coronary syndromeprognosislikelihood ratios
Type
Em Advances • Innovations En Mu
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 1 , January 2004 , pp. 22 - 30
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

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