Health Outcomes Categorized by Current and Previous Definitions of Acute Myocardial Infarction in an Unselected Cohort of Troponin-Naïve Emergency Department Patients

Kavsak, Peter A.; MacRae, Andrew R.; Palomaki, Glenn E.; Newman, Alice; Ko, Dennis T.; Lustig, Viliam; Tu, Jack V.; Jaffe, Allan S.

doi:10.1373/clinchem.2006.073403

Cited by 24 publications

(22 citation statements)

References 22 publications

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“…Since our study population was not clinically triaged by cTnI in 1996 (10 -12 ), an assessment is possible of the long-term risks associated with different cTnI concentrations absent the aggressive interventional nature of modern practice. We have previously reported that higher peak cTnI concentrations are associated with a greater risk for early death/AMI within 1 year (12 ). The findings from this study support the notion of a concentration-dependent relationship for an increased long-term risk for subsequent death/AMI/CHF events after 2 years.…”

Section: Resultssupporting

confidence: 86%

“…During the study, we used data from 6 commercial quality-control samples together with data on the observed analytical detection limit of the assay to confirm that the assay did indeed achieve the stated imprecision (i.e., 0.06 g/L with 10% CV) (11 ). We have previously reported short-term outcomes using cutoffs at both the 10% CV (0.06 g/L) and the 99th percentile (0.04 g/L), as well as for intermediate and high peak cTnI classifications (12 ). Briefly, the intermediate group comprised patients with a peak AccuTnI cTnI value at or above the manufacturer's reported 99th percentile (0.04 g/L) and at or below the highest reported 99th percentile cutoff (5,12 ).…”

Section: Troponin Group Assignmentsmentioning

confidence: 64%

“…We have previously reported short-term outcomes using cutoffs at both the 10% CV (0.06 g/L) and the 99th percentile (0.04 g/L), as well as for intermediate and high peak cTnI classifications (12 ). Briefly, the intermediate group comprised patients with a peak AccuTnI cTnI value at or above the manufacturer's reported 99th percentile (0.04 g/L) and at or below the highest reported 99th percentile cutoff (5,12 ).…”

Section: Troponin Group Assignmentsmentioning

confidence: 99%

“…We obtained research ethics board approval to investigate health outcomes in our study population via linkage to the Registered Persons Data Base for mortality outcomes and the Canadian Institute for Health Information Discharge Abstract Database for Ontario hospital discharges associated with AMI or congestive heart failure (CHF) (12,14 ). Based on the earliest subsequent readmission for AMI or CHF and the death date, we created indicators to reflect whether an event (death or readmission) occurred within 2, 5, and 8 years after presentation.…”

Section: Health Outcomesmentioning

confidence: 99%

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Long-Term Health Outcomes Associated with Detectable Troponin I Concentrations

et al. 2007

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Background: Recent data suggest that older men with detectable cardiac troponin I (cTnI) concentrations that remain below the 99th percentile concentration cutoff are at increased risk for subsequent cardiovascular events. We designed this study to extend this observation by examining risk prediction in both men and women presenting to an emergency department with chest discomfort. Methods: We obtained data for all-cause mortality and hospital discharges associated with either acute myocardial infarction (AMI) or congestive heart failure (CHF) for up to 8 years after the initial presentation in 448 patients who originally presented in 1996 with acute coronary syndrome (ACS). We performed retrospective analysis for cTnI (AccuTnI™; Beckman Coulter) in frozen plasma samples based on the patients' reported time from onset of symptoms. Peak cTnI concentration was used for risk assessment. Results: Patients with cTnI concentrations >0.02 g/L (i.e., limit of detection), including those whose peak values remained below the 99th percentile (0.04 g/L), were at greater risk for death and AMI/CHF readmissions at 2, 5, and 8 years of follow-up compared with those with peak cTnI <0.02 g/L. All results were statistically significant (P <0.05) except for death within 2 years among patients with normal but detectable cTnI (0.02 to 0.03 g/L), relative to the group with values <0.02 g/L. Kaplan-Meier analyses indicated that both

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Section: Resultssupporting

confidence: 86%

Section: Troponin Group Assignmentsmentioning

confidence: 64%

Section: Troponin Group Assignmentsmentioning

confidence: 99%

Section: Health Outcomesmentioning

confidence: 99%

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Long-Term Health Outcomes Associated with Detectable Troponin I Concentrations

et al. 2007

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“…Kavsak and colleagues analyzed the outcomes of a cohort of chest pain patients with cTnI values between 0.04 and 0.1 ng/L and found that these patients experienced adverse cardiovascular events that were greater than those with cTnI values below 0.04 ng/L. 6 Therefore, although the POC process time is likely much shorter than our current laboratory process time, the reduction in sensitivity would negatively impact patient morbidity and mortality. As more sensitive POC cTn assays become available, large-scale, prospective studies will be needed to determine their actual impact on ED patient flow and clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

Root cause analysis of delays to discharge for patients held for serial cardiac troponin levels

Owen

Worster

Waines

et al. 2014

CJEM

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Objective: Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non-ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays. Methods: We reviewed a random sample of ED discharges following a second normal cTn measurement and recorded associated event times. The central tendency of time intervals is reported as median and mean number of minutes with interquartile ranges (IQRs) and 95% confidence intervals, respectively. Results: From 9,656 eligible cases, we randomly selected 226 for data collection. The median number of minutes for each event are as follows: from ordering the second cTn measurement to the time of ED discharge was 90 minutes (IQR 65-120); for blood collection from the time the collection was ordered for was 0 minutes (IQR 212-0); from blood collection to the time the blood was transported to the laboratory was 9 minutes (IQR 2-19); laboratory process duration was 44 minutes (IQR 39-52); from when the results were available to the time the patient was discharged was 30 minutes (IQR 15-52). Conclusions: For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay. RÉ SUMÉObjectif: Bien souvent, les patients qui pré sentent des symptô mes d'isché mie cardiaque au service des urgences (SU) doivent subir une deuxième mesure du taux de troponine cardiaque (TC) pour que soit é carté tout risque d'infarctus du myocarde sans sus-dé calage du segment ST.L'é tude visait à mesurer la duré e totale d'exé cution et la duré e des é vé nements connexes suivant la demande de la deuxiè me mesure du taux de TC en vue de l'autorisation de sortie, et ce, afin de cerner les causes fondamentales des dé lais. Mé thode: Nous avons procé dé à un é chantillonnage alé atoire des sorties du SU à la suite d'une deuxiè me mesure normale du taux de TC, et consigné la duré e des é vé nements connexes. La tendance centrale des intervalles de temps est exprimé e sous forme de nombres mé dians et moyens de minutes, avec des é carts interquartiles (EIQ) et des intervalles de confiance à 95%, respectivement. Ré sultats: Sur 9,656 cas ré pondant aux critè res de sé lection, 226 ont é té choisis au hasard en vue de la collecte de donné es. Le nombre mé dian de minutes relatif à chaque é vé nement s'est é tabli comme suit: le temps é coulé depuis la demande de la deuxiè me mesure de TC jusqu'à la sortie du SU s'est é levé à 90 minutes (EIQ: 65-120); celui é coulé depuis la demande du pré lè vement de sang jusqu'à l'acte comme tel, à 0 minute (EIQ: 212-0); celui é coulé depuis le pré lè vement de sang jusqu'au transport au laboratoire, à 9 minutes (EIQ: 2-19); la duré e de traitement au laboratoire, à 44 minutes (EIQ: 39-52); et le t...

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Aktuelle Assayentwicklung für kardiale Troponine

Schulz¹,

Schimke

2008

Herz

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Cardiac troponins play a major role in the diagnostic work-up of acute coronary syndrome/myocardial infarction. Elevations were demonstrated also in other, rather nonischemic diseases like pulmonary embolism or acute heart failure. Stepwise improvement in the accuracy of the commercially available assays allowed detection of low-level concentrations of cardiac troponins, which were previously partially classified to be normal (between the limit of detection and the 99 th percentile by < 10% coefficient of variance). These low concentrations were associated with the detection of chronic cardiovascular pathologies and an increased risk of future cardiovascular events. Recently, ten to 100 times more sensitive assays (so-called high sensitive or ultra sensitive assays) have been developed. The clinical importance of those now measurable troponin values is currently under intensive investigation. The expected additional clinical and prognostic information from such low- and even lowest-level troponin values pose a special challenge. Specifically, the question has been raised, whether the established single cutoff approach for diagnosing myocardial infarction should not be complemented by another, lower cutoff usable for the detection of other (stable) cardiovascular pathologies with lower but still substantial risk.

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Health Outcomes Categorized by Current and Previous Definitions of Acute Myocardial Infarction in an Unselected Cohort of Troponin-Naïve Emergency Department Patients

Cited by 24 publications

References 22 publications

Long-Term Health Outcomes Associated with Detectable Troponin I Concentrations

Long-Term Health Outcomes Associated with Detectable Troponin I Concentrations

Root cause analysis of delays to discharge for patients held for serial cardiac troponin levels

Aktuelle Assayentwicklung für kardiale Troponine

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