The role of cardiac troponin I in determining the necessity for exercise electrocardiography in low risk patients with chest pain

Fleming, S; Divilly, M.; Chakravarthi, P.I.S.; Grimes, H.; Daly, Kieran

doi:10.1007/bf03167689

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…Indeed, the serum troponin level provides a valuable insight into the morphological basis of ACS, in that angiographic studies have shown that elevated troponin levels are more likely to be associated with the presence of complex atheromatous lesions and visible thrombus formation [14,17,19]. The degree of elevation of troponin could also guide the preference for the specific pharmacological or other intervention modality, as with the use of enoxaparin [20], platelet receptor antagonists such as tirofiban and abcimixab [21,22] and procedures including coronary angioplasty, percutaneous transluminal coronary angioplasty, stent insertion, rotational atherectomy and stress testing [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Establishing a Gradient of Risk in Patients with Acute Coronary Syndromes Using Troponin I Measurements

Al-Harbi¹,

Suresh

Zubaid

et al. 2002

Med Princ Pract

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Objective: To evaluate the role of serum troponin I (TnI) estimations in the early risk stratification of patients with acute coronary syndromes (ACS) subsequently diagnosed as acute myocardial infarction (AMI) or unstable angina (UA). Subjects and Methods: Blood samples were collected from 86 patients admitted to the Coronary Care Unit of the Mubarak Al-Kabeer Hospital, Kuwait, with a diagnosis of ACS on admission (TnI-1) and after 8 h (TnI-2) and 16 h (TnI-3). Blood was also collected from 38 age-matched healthy controls for comparison. Serum TnI was measured by paramagnetic particle chemiluminescent immunoassay. Results: Serum TnI of <0.05 ng/ml, corresponding to the 99th percentile, was established for healthy subjects. Patients diagnosed as UA had a 99th percentile TnI-1 value of about 0.30 ng/ml. The best specificity and sensitivity for ACS was obtained for TnI-2; indeed, TnI-2 >0.3 ng/ml gave a >80% certainty of diagnosis of AMI. Also, TnI-2 <0.3 ng/ml in ACS patients was approximately 80% sensitive for the diagnosis of UA but relatively nonspecific (approximately 40%). Specificity for TnI-2 for the diagnosis of UA improved to about 90% by narrowing the diagnostic range to 0.05–0.3 ng/ ml. TnI values in UA increased by <100% at 8 h, while in AMI, this increase was up to 1,000%. Conclusion: In the evaluation of ACS, admission and 8-hour serum TnI <0.05 ng/ml is probably not cardiac in origin; serum TnI >0.3 ng/ml on admission and increasing rapidly by 8 h is likely AMI, and serum TnI >0.05 and <0.3 ng/ml on admission with a mild increase by 8 h is likely due to UA.

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Section: Discussionmentioning

confidence: 99%

Establishing a Gradient of Risk in Patients with Acute Coronary Syndromes Using Troponin I Measurements

Al-Harbi¹,

Suresh

Zubaid

et al. 2002

Med Princ Pract

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“…Lindahl et al [31], in a re-analysis of the FRISK data [17], have demonstrated improved NPV of considering peak troponin T at a lower discriminator level (<0.06 ng/ml). In an analysis, at our department, of 98 patients presenting to the emergency room with a history of resting chest pain but no electrocardiographic change, peak cTnI of less than 0.03 ng/ml (Beckmann Access population 98th percentile value) was associated with a 6-month event-free follow-up [32]. Identification and early discharge of such patients may present considerable health care cost saving and further trials examining the important area of cut-point selection are warranted.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Troponins in Suspected Acute Coronary Syndrome

Fleming

Daly²

2001

Cardiology

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We performed a meta-analysis of published trials to determine the predictive value of cardiac troponin I (cTnI) and T (cTnT) levels for adverse events (death and myocardial infarction) in acute coronary syndrome without ST elevation (ACS). The accumulated odds ratio (OR) for adverse events (30 days) in ACS with elevated cTnI (n = 5,759) and cTnT (n = 5,483) was 4.9 (95% confidence interval, CI, 3.9–6.2) and 4.6 (95% CI 3.8–5.5), respectively. Trials that mandated timed serum sampling (6 or more hours after symptom onset) had an improved predictive value for elevated cTnI (n = 2,807, OR 8.8; 95% CI 5.9–13.2) and cTnT (n = 1,990, OR 8.5; 95% CI 5.9–12.5). In conclusion, cTnI and cTnT provide similar information in ACS. The risk of adverse events is 4-fold higher in patients with suspected ACS and elevated serum cTn. For patients with an elevated timed (6-hour) sample the risk is over 8-fold higher.

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Cardiac troponin I in patients with chest pain

Galvin¹

2000

Ir J Med Sci

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The role of cardiac troponin I in determining the necessity for exercise electrocardiography in low risk patients with chest pain

Abstract: CTnI in the normal range can identify patients with acute chest pain who have a negligible event rate and for whom exercise electrocardiography is not required.

Cited by 3 publications

References 14 publications

Establishing a Gradient of Risk in Patients with Acute Coronary Syndromes Using Troponin I Measurements

Establishing a Gradient of Risk in Patients with Acute Coronary Syndromes Using Troponin I Measurements

Cardiac Troponins in Suspected Acute Coronary Syndrome

Cardiac troponin I in patients with chest pain

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