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KMID : 0385920230340060586
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Journal of the Korean Society of Emergency Medicine
2023 Volume.34 No. 6 p.586 ~ p.598
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Validation of high-sensitivity troponin I levels for major adverse cardiac events in low risk chest pain patients
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Ryu Hyun-Jin
Park Ha-Young
Hwang Tae-Sik
Kim Han-Byeol
Lee Ju-Hong
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Abstract
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Objective: This study examined whether the efficiency of the level of detection (LOD) and upper reference limit (URL) for high-sensitivity cardiac troponin I (hs-cTnI) is increased when major adverse cardiovascular events (MACEs) occur in patients with low-risk chest pain who visit the emergency department (ED) and how long they stay in the ED.
Methods: The URL for hs-cTnI used in the hospital improved from 0.04 ng/mL (LOD <0.0041 ng/mL) in 2018 to 19.8 pg/mL (LOD <2.3 pg/mL) in 2019. In these two years, the occurrence of MACEs, frequency of hs-cTnI follow-up in the ER, and the length of stay in the ER were compared. In addition, the three calculated risk assessment scores for the safety level of early discharge were compared.
Results: In 2018, there were six MACEs out of 120 patients (5.0%), no cardiac deaths, one acute myocardial infarction (AMI), and five unplanned coronary revascularizations. In 2019, six MACEs out of 105 patients (5.7%) were all unplanned coronary revascularizations without any cardiac deaths or AMIs.
Conclusion: Although the level of hs-cTnI measurement was improved, there was no difference in the incidence of MACEs in patients with low-risk chest pain who were discharged from the ED, and the number of hs-cTnI follow-ups and time in the ED increased. Interestingly, there were only short-term MACEs and no medium-term MACEs. In addition, there was little to no coronary artery occlusion disease. The risk assessment score combined with hs-cTnI improved the predictive performance for MACEs.
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KEYWORD
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Troponin I, Acute coronary syndrome, Chest pain
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