title: High sensitivity troponin T provides useful prognostic information in non-acute chest pain.
abstract: OBJECTIVE
  To evaluate the prognostic value of high-sensitivity troponin T (hs-cTnT) in patients who present to General Practitioners (GPs) with non-acute chest pain.
  
  
  METHODS
  A total of 625 patients who were referred by their GPs to a regional Rapid Access Chest Pain Clinic in Tayside, Scotland were consented and recruited. Diamond-Forrester pretest probability of coronary artery disease (CAD) was used to select patients with intermediate and high-pretest probability. Hs-cTnT and B-type Natriuretic Peptide (BNP) were measured and final diagnosis recorded. Twelve-month follow-up for cardiac events and hospital admission data was collected. Sensitivity, specificity, positive predictive value and negative predictive value (NPV), for both prognosis and diagnosis, were produced using various pre-specified cut-off values for hs-cTnT and BNP.
  
  
  RESULTS
  A total of 579 patients were included in the final analysis. Of these, 477 had intermediate/high-pretest probability of CAD. A total of 431 (90.4%) of patients had a hs-cTnT ≤14 ng/l. In this study, hs-cTnT of 14 ng/l was the best cut-off for ruling out if a patient would have an admission for cardiac chest pain in the following 12 months (specificity 90%, NPV 91.4%). It performed well as a predictor of a subsequent negative diagnosis of cardiac chest pain with a specificity of 92.4% and NPV of 83.5%.
  
  
  CONCLUSIONS
  Hs-cTnT, at the same level currently used in clinical practice as a diagnostic cut-off for myocardial infarction and acute coronary syndromes, is also a clinically-meaningful indicator for further 12-month cardiac chest pain hospital admissions in patients with non-acute chest pain referred to chest pain clinics by GPs.
authors.affiliation: Centre for Cardiovascular & Lung Biology, Division of Medical Sciences, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. j.george@dundee.ac.uk
authors.forename: J
authors.initials: J
authors.lastname: George
authors.forename: D
authors.initials: D
authors.lastname: Jack
authors.forename: G
authors.initials: G
authors.lastname: Mackle
authors.forename: T S
authors.initials: TS
authors.lastname: Callaghan
authors.forename: L
authors.initials: L
authors.lastname: Wei
authors.forename: C C
authors.initials: CC
authors.lastname: Lang
authors.forename: E
authors.initials: E
authors.lastname: Dow
authors.forename: A D
authors.initials: AD
authors.lastname: Struthers
mesh_terms: D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T; D020097:Natriuretic Peptide, Brain