Publication: The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: An observational study
Issued Date
2018-10-22
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18651380
18651372
18651372
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2-s2.0-85055330338
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Mahidol University
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SCOPUS
Bibliographic Citation
International Journal of Emergency Medicine. Vol.11, No.1 (2018)
Suggested Citation
Onlak Ruangsomboon, Pattaraporn Mekavuthikul, Tipa Chakorn, Apichaya Monsomboon, Nattakarn Prapruetkit, Usapan Surabenjawong, Chok Limsuwat, Sattha Riyapan, Wansiri Chaisirin The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: An observational study. International Journal of Emergency Medicine. Vol.11, No.1 (2018). doi:10.1186/s12245-018-0204-9 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/46245
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Title
The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: An observational study
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Abstract
© 2018 The Author(s). Background: The 3-h high-sensitivity cardiac troponin T (hs-cTnT) algorithm is the most commonly used scheme to diagnose acute myocardial infarction. The 1-h hs-cTnT algorithm has recently been approved by the European Society of Cardiology as an alternative algorithm for earlier diagnosis. If the hs-cTnT test cannot discriminate the diagnosis of the patient at 1 h, the patient is defined as observational group. Their test must be repeated at 3 h. A high prevalence of this group may indicate a low clinical utility of the 1-h hs-cTnT algorithm. This study was aimed to estimate the proportion of the observational group in Thai emergency department (ED) patients and also the time to rule-in/out between both the algorithms. Methods: A historical control study was conducted in patients with chest pain for 1-12 h at the ED of Siriraj Hospital, Bangkok, Thailand. The study compared two groups: one prospective group of all patients evaluated with the 1-h hs-cTnT algorithm between June and September 2017 and one historical control group evaluated with the 3-h hs-cTnT algorithm between January and March 2017. Results: A total of 130 patients were included (3-h hs-cTnT algorithm group n = 65 and 1-h hs-cTnT algorithm group n = 65). Twelve patients [18.5% (95% CI 10.0-30.1)] were categorized as observational group in the 1-h hs-cTnT algorithm group. The mean rule-in/out times in the 3-h hs-cTnT algorithm and 1-h hs-cTnT algorithm groups were 238 min (SD 63.3) and 134 min (SD 68.5), respectively (both p < 0.001). The time to disposition was also shortened in the 1-h hs-cTnT algorithm group (p < 0.001). Multivariable regression analysis performed to identify and adjust for confounders among patient characteristics revealed no significant confounders. Conclusions: The use of the 1-h hs-cTnT algorithm in the ED resulted in an acceptable proportion in the observational group and a decreased time to rule-in/out compared with the 3-h hs-cTnT algorithm.