Cor Vasa 2019, 61(6):584-587 | DOI: 10.33678/cor.2019.051

(Application of 0/1-h high sensitivity cardiac troponin algorithm in the cardiology outpatient department)

Jan Málek^a, Pavel Živný^b, Petr Vojtíšek^a, Jan Matějka^a

^a Kardiologické oddělení, Pardubická nemocnice, Pardubice

^b Oddělení klinické biochemie a diagnostiky, Pardubická nemocnice, Pardubice

Background: Chest pain is one of the commonest reasons for emergency department visits. Acute myocardial infarction is diagnosed in minority of these patients. Diagnostic algorithms based on high-sensitivity troponin assays enable fast and safe AMI diagnostics. The aim of the present study is to explore effectivity of one-hour (0/1-h) high sensitivity troponin algorithm in management of patients with chest pain in outpatients department of Cardiology department and to describe subgroups of patients.

Methods: Patients with chest pain presenting to outpatients department of Cardiology department of Pardubice District Hospital were prospectively examined with 0/1-h high sensitivity troponin I (ADVIA Centaur TNIH, Siemens Healthineers, Erlangen, Germany). According to troponin I concentration and its dynamics, they were divided with use of validated algorithm into rule-out, observe and rule-in. Patients with STEMI and on hemodialysis were excluded. We compare subgroups of patients in their basic characteristics.

Results: From 1st May to 31st June 2018 135 patients were prospectively included. Based on hsTnI and 0/1-h algorithm they were divided into three subgroups - rule-out, observe and rule-in. 64 (47.4%) patients were classified to rule-out, 59 (43.7%) to observe and 12 patients (8.9%) to rule-in subgroup. Non-STEMI was diagnosed in 8 patients (5.9%) and all of these were classified as rule-in. Negative and positive predictive value was 100% and 75%, respectively. The observed subgroup had significantly more risk factors than rule-out patients.

Conclusion: Management of chest pain patients with 0/1-h algorithm is effective in the outpatients department. It enables fast and safe rule-out of AMI in one half of patients. Observed subgroup patients have more risk factors and should be further investigated.

Keywords: Algorithm, High sensitivity troponin, Myocardial infarction, Troponin

Received: April 8, 2019; Accepted: June 15, 2019; Published: December 15, 2019  Show citation