title: Usefulness of high-sensitivity troponin T for the evaluation of patients with acute chest pain and no or minimal myocardial damage.
abstract: BACKGROUND
  Although high-sensitivity troponins allow early diagnosis of acute myocardial infarction, their role for identification of acute coronary syndrome in patients with normal conventional troponin remains unclear.
  
  
  RESULTS
  A total of 446 patients presenting to the emergency department with chest pain and normal troponin (common practice assays) in 2 serial samples were included. Both samples were also centrally analyzed for high-sensitivity troponin T (hs-TnT) (Roche Diagnostics, Basel, Switzerland). Detection (>3 ng/L) and 99th percentile (≥ 14 ng/L) cutoffs of the maximum hs-TnT levels (hs-TnTmax) were considered. The end points were acute coronary syndrome diagnosis and the composite of in-hospital revascularization or 30-day cardiac events.
  
  
  RESULTS
  Acute coronary syndrome was adjudicated to 84 patients (19%), and 62 (14%) had the composite end point. In univariate setting, hs-TnTmax >3 ng/L exhibited high sensitivity (87% and 92%, respectively) and negative predictive value (93% and 97%) for both end points, whereas hs-TnTmax ≥ 14 ng/L provided high specificity (90% and 89%), although low positive predictive values (40% and 33%). After adjusting for clinical (pain characteristics and risk factors) and electrocardiographic data, there was a stepped increase of risk across hs-TnTmax categories (≤ 3, >3 but <14, and ≥ 14 ng/L) for both end points; however, the discriminative capacity added was marginal (integrated discrimination improvement of 2.6% and 3.5%, respectively).
  
  
  CONCLUSIONS
  Clinical and electrocardiographic data remain the most important tools for the evaluation of patients with chest pain and with no or minimal myocardial damage. The main contribution of hs-TnT is the high negative predictive value of undetectable levels (≤ 3 ng/L).
authors.affiliation: Servicio de Cardiología Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain. sanchis_juafor@gva.es
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Alfredo
authors.initials: A
authors.lastname: Bardají
authors.forename: Xavier
authors.initials: X
authors.lastname: Bosch
authors.forename: Pablo
authors.initials: P
authors.lastname: Loma-Osorio
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sánchez
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Arturo
authors.initials: A
authors.lastname: Carratalá
authors.forename: José A
authors.initials: JA
authors.lastname: Barrabés
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D059787:Acute Pain; D000368:Aged; D000465:Algorithms; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D009206:Myocardium; D011237:Predictive Value of Tests; D020107:Troponin T / Q000097:blood
chemical_list: D020107:Troponin T