title: Can troponin I measurement predict short-term serious cardiac outcomes in patients presenting to the emergency department with possible acute coronary syndrome?
abstract: OBJECTIVE
  To determine the ability of troponin I (TnI) measurement to predict the likelihood of a serious cardiac outcome over the subsequent 72 hours in patients presenting to the emergency department (ED) with symptoms suggestive of an acute coronary syndrome.
  
  
  METHODS
  This prospective observational study enrolled consecutive patients presenting to 2 urban tertiary care hospital EDs over a 5-week period. Eligible patients included those for whom a TnI test was ordered within 24 hours of arrival and in whom no serious cardiac outcome occurred before the test result was available. Patients were followed for 72 hours and serious cardiac outcomes documented; these included cardiovascular death, myocardial infarction, congestive heart failure, serious arrhythmia and refractory pain. We calculated likelihood ratios (LRs) to describe the association of the TnI result with serious cardiac outcomes.
  
  
  RESULTS
  Of the 352 enrolled patients, 20 had a serious cardiac outcome within 72 hours of ED presentation. The derived LRs (and 95% confidence interval [CI]) were 0.5 (0.3-0.9) for TnI values <0.5 microg/L, 1.6 (0.4-6.5) for TnI values from 0.5 to 2.0 microg/L, 5.8 (1.7-19.5) for TnI values from >2.0 to 10.0 microg/L and 14.4 (4.8-42.9) for TnI values >10.0 microg/L.
  
  
  CONCLUSIONS
  TnI values >2.0 microg/L are associated with an increased probability of serious cardiac outcomes within 72 hours. TnI values between 0.5 and 2.0 microg/L are weakly positive predictors. TnI values <0.5 microg/L have LRs in the range of 0.5 and thus are weakly negative predictors, not substantially decreasing the likelihood of serious cardiac outcomes, particularly in patients with a moderate or high pretest probability.
authors: Department Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. hillstev@hhsc.ca
authors: Stephen A
authors: SA
authors: Hill
authors: P J
authors: PJ
authors: Devereaux
authors: Lauren
authors: L
authors: Griffith
authors: John
authors: J
authors: Opie
authors: Matthew J
authors: MJ
authors: McQueen
authors: Akbar
authors: A
authors: Panju
authors: Eric
authors: E
authors: Stanton
authors: Gordon H
authors: GH
authors: Guyatt