Meta-Analysis: Single Cardiac Troponin Test Plus ECG Can Quickly Rule Out MI — Physician’s First Watch

Medical News |
April 18, 2017

Meta-Analysis: Single Cardiac Troponin Test Plus ECG Can Quickly Rule Out MI

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH

Use of a single high-sensitivity cardiac troponin T (hs-cTnT) measurement plus electrocardiogram can rule out acute myocardial infarction in patients who present to the emergency department with chest pain, according to an Annals of Internal Medicine meta-analysis.

Researchers examined data from 11 prospective studies comprising over 9200 adults who presented with possible acute coronary syndrome and underwent both hs-cTnT measurement and ECG.

Roughly 31% of patients had negative test results — i.e., troponin below 0.005 µg/L plus no new ischemia on ECG — and were considered low risk for MI. Of these, 0.5% had an MI during the index admission. The overall sensitivity of the testing strategy was 98.7%; the negative predictive value was 99.3%.

Dr. Harlan Krumholz, editor-in-chief of NEJM Journal Watch Cardiology, comments: "This analysis indicates that a nonischemic ECG and a single negative hs-cTnT only misses about 1 in 100 MIs — and can provide rapid, useful information in an assessment." However, he stresses the importance of the authors' recommendation against using this strategy for people presenting within 3 hours of symptom onset, given that half of low-risk patients who had an MI had blood draws in that time frame.

Reader Comments (1)

Carlos A Selmonosky,MD Physician, Family Medicine/General Practice

The advent of high sensitivity troponins will allow the discharge of patients admitted with chest pain with a very low probability that they will developed a MACE in the next 30 days after discharge.The problem became now the enormous number of patients that will be discharged with the diagnosis of Non Coronary Chest Pain. These patient in greater numbers became Unexplained Chest Pain Patients,it is well known that patients adequately treated for reflux esophagitis continue to have chest pains.Also patient treated with stents for obvious coronary stenosis continue to have non ischemic chest pain.Patients with well known coronary insufficiency continue to have non ischemic chest pain.
The fact that Thoracic Outlet Syndrome can be responsible for the complains of chest pain is completely ignored.Its diagnosis can be made in few minutes by performing a Diagnostic Triad associated or not with the White Hand Sign, the quality of life of these patients with Unexplained Chest Pain can be comparared to the QOL of cardiac failure patients without the mortality.The cost to the health system because of the numerous expensive non diagnostic tests performed in the patients can be a significant part of the budget.Also the association of coronary artery disease ,reflux esophagitis and thoracic outlet syndrome, Selmonosky Triad,can be significant.See on request.

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