Diagnosis of Unstable Angina Pectoris Has Declined Markedly with the Advent of More Sensitive Troponin Assays

D’Souza, Maria; Sarkisian, Laura; Saaby, Lotte; Poulsen, Tina Svenstrup; Gerke, Oke; Larsen, Torben Bjerregaard; Diederichsen, Axel Cosmus Pyndt; Jangaard, Nikolaj; Diederichsen, Søren Zöga; Hosbond, Susanne; Hove, Jens D.; Thygesen, Kristian; Mickley, Hans

doi:10.1016/j.amjmed.2015.01.044

Cited by 50 publications

(31 citation statements)

References 39 publications

(45 reference statements)

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“…131 In addition, it should be noted that with the implementation of cTn and hs-cTn assays, the frequency of unstable angina will decrease and the diagnosis of NSTEMI will increase. 132,133 The magnitude of these changes using hs-cTn assays have been reported in the range of 18−30%. 134 135 This strategy should not be used in those who present early, i.e.…”

Section: Operationalizing Criteria For Myocardial Injury and Infarctionmentioning

confidence: 99%

Fourth Universal Definition of Myocardial Infarction (2018)

Thygesen¹,

Alpert²,

Jaffe³

et al. 2018

Circulation

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Section: Operationalizing Criteria For Myocardial Injury and Infarctionmentioning

confidence: 99%

Fourth Universal Definition of Myocardial Infarction (2018)

Thygesen¹,

Alpert²,

Jaffe³

et al. 2018

Circulation

Self Cite

2,489

1,773

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“…However, with more sensitive cTn assays, the diagnosis of unstable angina has decreased significantly. 44,45 This study has limitations. A modified Diamond-Forrester rule was retrospectively used as a surrogate for clinical suspicion because this information was not collected.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

McCord

Cabrera

Lindahl

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background— The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. Methods and Results— Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs ( P =0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs ( P =0.03). Conclusions— Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.

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“…2 In addition to patients with CK elevation (NSTEMI+CK), a large number of patients formerly classified by CK as UA are now ruled-in by cTn as NSTEMI (NSTEMI-CK). 3- 5 We have previously reported the clinical presentation, treatment and in-hospital outcomes of patients with STelevation MI (STEMI), NSTEMI+CK and NSTEMI-CK. 6 In-hospital mortality rates were comparable between STEMI and NSTEMI+CK, but patients with NSTEMI-CK had favorable outcomes despite their complicated background.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation　― The J-MINUET Study ―

Ishihara

Nakao

Kimura

et al. 2017

Circ J

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Diagnosis of Unstable Angina Pectoris Has Declined Markedly with the Advent of More Sensitive Troponin Assays

Cited by 50 publications

References 39 publications

Fourth Universal Definition of Myocardial Infarction (2018)

Fourth Universal Definition of Myocardial Infarction (2018)

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation　― The J-MINUET Study ―

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Diagnosis of Unstable Angina Pectoris Has Declined Markedly with the Advent of More Sensitive Troponin Assays

Cited by 50 publications

References 39 publications

Fourth Universal Definition of Myocardial Infarction (2018)

Fourth Universal Definition of Myocardial Infarction (2018)

Prognostic Utility of a Modified HEART Score in Chest Pain Patients in the Emergency Department

Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation ― The J-MINUET Study ―

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Product

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Long-Term Outcomes of Non-ST-Elevation Myocardial Infarction Without Creatine Kinase Elevation　― The J-MINUET Study ―