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.

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.