Next Article in Journal
Trends of Stem Cell Therapies in Age-Related Macular Degeneration
Previous Article in Journal
Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
Previous Article in Special Issue
Acute Phase Response and Non-Reproducible Elevated Concentrations with a High-Sensitivity Cardiac Troponin I Assay
Article

Clinical History and Detectable Troponin Concentrations below the 99th Percentile for Risk Stratification of Patients with Chest Pain and First Normal Troponin

1
Cardiology Department, University Clinic Hospital of València, Instituto de Investigación Sanitaria (INCLIVA), University of València, Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), 46010 València, Spain
2
Clinical Biochemistry Department, University Clinic Hospital of València, Instituto de Investigación Sanitaria (INCLIVA), 46010 València, Spain
3
Emergency Department, University Clinic Hospital of València, Instituto de Investigación Sanitaria (INCLIVA), 46010 València, Spain
*
Author to whom correspondence should be addressed.
Academic Editor: Maria Rubini Giménez
J. Clin. Med. 2021, 10(8), 1784; https://doi.org/10.3390/jcm10081784
Received: 5 April 2021 / Revised: 15 April 2021 / Accepted: 18 April 2021 / Published: 20 April 2021
(This article belongs to the Special Issue Improving the Diagnosis of Acute Myocardial Infarction)
Decision-making is challenging in patients with chest pain and normal high-sensitivity cardiac troponin T (hs-cTnT; <99th percentile; <14 ng/L) at hospital arrival. Most of these patients might be discharged early. We investigated clinical data and hs-cTnT concentrations for risk stratification. This is a retrospective study including 4476 consecutive patients presenting to the emergency department with chest pain and first normal hs-cTnT. The primary endpoint was one-year death or acute myocardial infarction, and the secondary endpoint added urgent revascularization. The number of primary and secondary endpoints was 173 (3.9%) and 252 (5.6%). Mean hs-cTnT concentrations were 6.9 ± 2.5 ng/L. Undetectable (<5 ng/L) hs-cTnT (n = 1847, 41%) had optimal negative predictive value (99.1%) but suboptimal sensitivity (90.2%) and discrimination accuracy (AUC = 0.664) for the primary endpoint. Multivariable analysis was used to identify the predictive clinical variables. The clinical model showed good discrimination accuracy (AUC = 0.810). The addition of undetectable hs-cTnT (≥ or <5 ng/L; HR, hazard ratio = 3.80; 95% CI, confidence interval 2.27–6.35; p = 0.00001) outperformed the clinical model alone (AUC = 0.836, p = 0.002 compared to the clinical model). Measurable hs-cTnT concentrations (between detection limit and 99th percentile; per 0.1 ng/L, HR = 1.13; CI 1.06–1.20; p = 0.0001) provided further predictive information (AUC = 0.844; p = 0.05 compared to the clinical plus undetectable hs-cTnT model). The results were reproducible for the secondary endpoint and 30-day events. Clinical assessment, undetectable hs-cTnT and measurable hs-cTnT concentrations must be considered for decision-making after a single negative hs-cTnT result in patients presenting to the emergency department with acute chest pain. View Full-Text
Keywords: troponin; chest pain; acute coronary syndrome; clinical evaluation; ischemic heart disease troponin; chest pain; acute coronary syndrome; clinical evaluation; ischemic heart disease
Show Figures

Figure 1

MDPI and ACS Style

Fernández-Cisnal, A.; Valero, E.; García-Blas, S.; Pernias, V.; Pozo, A.; Carratalá, A.; González, J.; Noceda, J.; Miñana, G.; Núñez, J.; Sanchis, J. Clinical History and Detectable Troponin Concentrations below the 99th Percentile for Risk Stratification of Patients with Chest Pain and First Normal Troponin. J. Clin. Med. 2021, 10, 1784. https://doi.org/10.3390/jcm10081784

AMA Style

Fernández-Cisnal A, Valero E, García-Blas S, Pernias V, Pozo A, Carratalá A, González J, Noceda J, Miñana G, Núñez J, Sanchis J. Clinical History and Detectable Troponin Concentrations below the 99th Percentile for Risk Stratification of Patients with Chest Pain and First Normal Troponin. Journal of Clinical Medicine. 2021; 10(8):1784. https://doi.org/10.3390/jcm10081784

Chicago/Turabian Style

Fernández-Cisnal, Agustín, Ernesto Valero, Sergio García-Blas, Vicente Pernias, Adela Pozo, Arturo Carratalá, Jessika González, José Noceda, Gema Miñana, Julio Núñez, and Juan Sanchis. 2021. "Clinical History and Detectable Troponin Concentrations below the 99th Percentile for Risk Stratification of Patients with Chest Pain and First Normal Troponin" Journal of Clinical Medicine 10, no. 8: 1784. https://doi.org/10.3390/jcm10081784

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Back to TopTop