dc.date.accessioned | 2021-05-04T18:17:40Z | |
dc.date.available | 2021-05-04T18:17:40Z | |
dc.date.created | 2021-03-02T16:21:58Z | |
dc.date.issued | 2021 | |
dc.identifier.citation | Johannessen, Tonje R. Atar, Dan Vallersnes, Odd Martin Larstorp, Anne Cecilie Kjeldsen Mdala, Ibrahimu Halvorsen, Sigrun . Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study. BMJ Open. 2021, 11(2), e046024 | |
dc.identifier.uri | http://hdl.handle.net/10852/85931 | |
dc.description.abstract | Objective This study aims to compare the rule-out safety of a single high-sensitivity cardiac troponin T (hs-cTnT) with the History, ECG, Age, Risk factors and Troponin (HEART) score in a low-prevalence primary care setting of acute myocardial infarction (AMI).
Participants Patients with non-specific symptoms suggestive of AMI were consecutively enroled at a primary care emergency clinic in Oslo, Norway from November 2016 to October 2018.
Methods After initial assessment by a general practitioner, hs-cTnT samples were drawn. AMI was ruled-out by a single hs-cTnT <5 ng/L measured ≥3 hours after symptom onset. The HEART score was calculated retrospectively; a score ≤3 of 10 points was considered low risk. We also calculated a modified HEART score using more sensitive hs-cTnT thresholds. The primary outcome was the diagnostic performance for the rule-out of AMI at the index event; the secondary the composite of AMI or all-cause death at 90 days.
Results Among 1711 patients, 61 (3.6%) were diagnosed with AMI, and 569 (33.3%) patients were assigned to single rule-out (<5 ng/L). With no AMIs in this group, the negative predictive value (NPV) and sensitivity were both 100.0% (95% CI 99.4% to 100.0% and 94.1% to 100.0%, respectively), and the specificity 34.5% (32.2% to 36.8%). The original HEART score triaged more patients as low risk (n=871), but missed five AMIs (NPV 99.4% (98.7% to 99.8%); sensitivity 91.8% (81.9% to 97.3%) and specificity 52.5% (50.0% to 54.9%)). The modified HEART score increased the low-risk sensitivity to 98.4% (91.2% to 100.0%), with specificity 38.7% (36.3% to 41.1%). The 90-day incidence of AMI or death in the single rule-out and the original and modified low-risk HEART groups were 0.0%, 0.7%, and 0.2%, respectively.
Conclusion In a primary care emergency setting, a single hs-cTnT strategy was superior to the HEART score in ruling out AMI. This rapid and safe approach may enhance the assessment of patients with chest pain outside of hospitals. | |
dc.language | EN | |
dc.publisher | BMJ Publishing Group | |
dc.rights | Attribution-NonCommercial 4.0 International | |
dc.rights.uri | https://creativecommons.org/licenses/by-nc/4.0/ | |
dc.title | Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study | |
dc.type | Journal article | |
dc.creator.author | Johannessen, Tonje R. | |
dc.creator.author | Atar, Dan | |
dc.creator.author | Vallersnes, Odd Martin | |
dc.creator.author | Larstorp, Anne Cecilie Kjeldsen | |
dc.creator.author | Mdala, Ibrahimu | |
dc.creator.author | Halvorsen, Sigrun | |
cristin.unitcode | 185,52,15,0 | |
cristin.unitname | Avdeling for allmennmedisin | |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 1 | |
dc.identifier.cristin | 1894977 | |
dc.identifier.bibliographiccitation | info:ofi/fmt:kev:mtx:ctx&ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=BMJ Open&rft.volume=11&rft.spage=e046024&rft.date=2021 | |
dc.identifier.jtitle | BMJ Open | |
dc.identifier.volume | 11 | |
dc.identifier.issue | 2 | |
dc.identifier.doi | https://doi.org/10.1136/bmjopen-2020-046024 | |
dc.identifier.urn | URN:NBN:no-88608 | |
dc.type.document | Tidsskriftartikkel | |
dc.type.peerreviewed | Peer reviewed | |
dc.source.issn | 2044-6055 | |
dc.identifier.fulltext | Fulltext https://www.duo.uio.no/bitstream/handle/10852/85931/1/Johannessen%2Bet%2Bal.pdf | |
dc.type.version | PublishedVersion | |
cristin.articleid | e046024 | |