title: Emergency department triage of patients with acute chest pain: definition of cardiac troponin I decisional value to manage patients without electrocardiographic evidence of ischemia.
abstract: The aim of this study was to define the use of a new cardiac troponin I (cTnI) assay for emergency patients with chest pain and no specific electrocardiographic changes consistent with the presence of ischemia. Patients (n = 106) admitted in Emergency/Cardiology Departments for chest pain and suspicion of acute coronary syndrome (ACS) were randomized into two diagnosis groups (ACS or non-ACS) by two independent cardiologists. cTnI measurements were performed at admission, and 6 hours and 12 hours later with a new generation assay (Access AccuTnI, Beckman Coulter). Using an upper reference limit of 0.04 microg/l, 27 patients had a cTnI elevation not related to the final diagnosis of ischemia; the positive predictive value (PPV) was 67% with specificity 48%. The decisional value was re-defined and set at 0.16 microg/l, a concentration corresponding to the 99th percentile of the non-ACS patient group. Precision (coefficient of variation) was 8% at this level, PPV 97% and specificity 98%. This new decisional value is now used in our institution and could be included in standard care guidelines to improve the management of patients presenting chest pain in emergency departments.
authors.affiliation: Service de Biochimie, AP-HP Hôpital Beaujon, Clichy, France. pascale.beyne@bjn.ap-hop-paris.fr
authors.forename: Pascale
authors.initials: P
authors.lastname: Beyne
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.forename: Patrick
authors.initials: P
authors.lastname: Werner
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourgoin
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.forename: Laurent
authors.initials: L
authors.lastname: Alliot
authors.forename: Habiba
authors.initials: H
authors.lastname: Daïkha
authors.forename: Michel
authors.initials: M
authors.lastname: Vidaud
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis; D002637:Chest Pain / Q000097:blood* / Q000150:complications; D004562:Electrocardiography; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012016:Reference Values; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014218:Triage / Q000379:methods*; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I