Unstable Angina

Braunwald, Eugene; Morrow, David A.

doi:10.1161/circulationaha.113.001258

Cited by 198 publications

(61 citation statements)

References 47 publications

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“…The reason for the good performance of undetectable hsTnT levels to rule-out ACS is primarily due to a better diagnostic performance in the UA subgroup and as shown in Figure 1 it is evident that the number of patients with ACS rises with increasing hsTnT levels in the normal range. These results imply, as suggested in recent reviews, [27][28][29][30] that UA with coronary thrombosis and micro embolization might cause some minimal myocardial damage resulting in hsTnT elevations below the 99 th percentile.…”

Section: Discussionsupporting

confidence: 80%

Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

Thelin

Melander

Öhlin

2014

European Heart Journal: Acute Cardiovascular Care

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Aims: To examine whether undetectable high sensitivity troponin T (hsTnT) can be used to safely rule out non-STelevation acute coronary syndrome (NSTE-ACS) (using the limit of detection (LOD) as the cut-off) and to compare this strategy to serial hsTnT and the use of combined hsTnT and copeptin. Methods: In this prospective observational study, 478 patients presenting with chest pain were consecutively included. A combined primary endpoint of ACS, non-elective revascularization and/or death of all causes was used. The follow-up period was 60 days. Results: NSTE-ACS was diagnosed in 107 (22%) patients during hospital stay. Undetectable hsTnT at admission ruled out NSTE-ACS with a negative predictive value of 94% (95% confidence interval (CI): 88-97) giving a sensitivity of 0.90 (95% CI: 0.80-0.95) versus 0.78 (95% CI: 0.66-0.87) for serial hsTnT testing, p=0.008. The combination of hsTnT and copeptin analysed at admission resulted in a sensitivity of 0.83 (95% CI: 0.74-0.89), p=0.07 for comparison with undetectable hsTnT. Conclusion: A single hsTnT test at presentation, using the LOD as the cut-off, appears to be a safe and time-saving strategy to rule out NSTE-ACS. Further, undetectable levels of hsTnT were associated with an excellent prognosis and none of the patients with undetectable hsTnT were diagnosed with NSTEMI. Together with ECG and clinical assessment this biomarker strategy might permit outpatient treatment of almost one third of the patients we currently admit for observation.

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Section: Discussionsupporting

confidence: 80%

Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

Thelin

Melander

Öhlin

2014

European Heart Journal: Acute Cardiovascular Care

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“…bezwzględny i 20-proc. względny wzrost) i związany z tym spadek liczby rozpoznań UA [7][8][9][10]. W porównaniu z NSTEMI pacjenci z UA nie mają martwicy mięśnia sercowego, ryzyko zgonu jest u nich znacząco niższe i wydają się odnosić mniej korzyści z intensyfikacji leczenia przeciwpłytkowego, jak również z wczesnej strategii inwazyjnej [2-4, 6-13].…”

Section: Niestabilna Dławica Piersiowa W Dobie Wysokoczułych Testów Tunclassified

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi¹,

Patrono²,

Collet³

et al. 2015

Kardiol Pol

210

165

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“…As early as 1992, Hamm and coworkers [79] reported that measurable cTnT in the serum of patients with unstable angina (UA) was a shortterm prognostic indicator for death or MI. However, due to the ls of the assay with LOD of 200 ng/L, more than 10 times the 99th percentile of today's cTnT assays, it appears that the positive results were rather diagnostic for AMI than for UA, which itself is a rapidly disappearing disease entity [80].…”

Section: Early Reports On Prognostic Value Of Ctn Assaysmentioning

confidence: 99%

High sensitivity cardiac troponin assays in the clinical laboratories

Jarolím

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

121

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Abstract:Immunoassays measuring cardiac troponins I or T have become firmly established as critical tools for diagnosing acute myocardial infarction. While most contemporary assays provide adequate diagnostic performance, the increased sensitivity and precision of the new, high sensitivity assays that have already been introduced into clinical practice, provide the potential to further shorten intervals between blood draws or the time needed to detect the first significant troponin elevation. In addition to the relatively modest benefits at the diagnostic end, the high sensitivity assays and the investigational ultrasensitive cardiac troponin assays offer improvements for predicting major adverse cardiovascular events, development of heart failure or transition to end-stage kidney disease. These novel high sensitivity assays can measure troponin concentrations in 50%-100% of healthy individuals and therefore allow for the distribution of troponin values within a healthy cohort to be measured, patient's baseline troponin levels to be monitored, and clinicians to be alerted of deteriorating cardiorenal conditions. We envisage that the high sensitivity assays will become important tools for predicting each patient's risk of future adverse events and for guiding and monitoring corresponding adjustments of preventative therapeutic interventions.

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Unstable Angina

Cited by 198 publications

References 47 publications

Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

Early rule-out of acute coronary syndrome using undetectable levels of high sensitivity troponin T

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

High sensitivity cardiac troponin assays in the clinical laboratories

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