Outcome of low-risk patients discharged home after a normal cardiac troponin I

Smith, Stephen W.; Tibbles, Carrie; Apple, Fred S.; Zimmerman, Marsha

doi:10.1016/j.jemermed.2003.12.021

Cited by 13 publications

(5 citation statements)

References 33 publications

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“…Although providers may be wary to discharge patients home after a single troponin I, there has been at least one retrospective chart review that looked at the results of 588 patients who were discharged home from the ED after a single normal cTnI was obtained 6–9 hours after symptom onset [14]. In this population, an adverse cardiac event (cardiac death or MI at 30 days) occurred in 2 patients (0.34%), both return visits for an NSTEMI.…”

Section: Discussionmentioning

confidence: 99%

Can We Exclude the Diagnosis of Non-ST Segment Myocardial Infarction on the Basis of a Single Troponin I and a Symptom Duration ≥8 Hours?

2011

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Background. The use of a single troponin measurement to exclude the diagnosis of non-ST segment myocardial infarction (NSTEMI) in patients that present with ischemic symptom duration ≥8 hours is sometimes used in the Emergency Department. Study Objective. To describe the characteristics of patients with initial nondiagnostic troponin values who develop a positive troponin while in the Emergency Department and to evaluate whether NSTEMI can be excluded using symptom duration ≥8 hours and initial troponin I. Methods. Retrospective chart review of patients evaluated for NSTEMI in the Emergency Department. Results. 4,510 patients had at least two troponin I values obtained during the two-year study period. 115 (2.5%) of these patients had an initially nondiagnostic (<0.6 ng/mL) and subsequent positive (≥0.6 ng/mL) troponin I result. Twenty-five (22%) of the 115 had duration of symptoms ≥8 hours. Of these 25 patients, 18 had an intermediate first troponin value (i.e., >0.06 ng/mL, but <0.6 ng/mL). Only two of the remaining seven patients had a final primary diagnosis of NSTEMI. Conclusion. The use of a negative initial troponin I together with a symptom onset of ≥8 hours defines a population with a very low incidence of a hospital diagnosis of NSTEMI.

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Section: Discussionmentioning

confidence: 99%

Can We Exclude the Diagnosis of Non-ST Segment Myocardial Infarction on the Basis of a Single Troponin I and a Symptom Duration ≥8 Hours?

2011

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“…16 Based upon conventional protocols involving cardiac muscle enzyme concentrations, many patients in this group would stay in hospital for up to 72 hours, placing unnecessary burden on hospital bed occupancy.…”

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confidence: 99%

Cardiac troponins

2004

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“…These studies found a sensitivity of 95% for troponin testing in the diagnosis of myocardial infarction if blood is drawn at least 8 h after the onset of symptoms. Furthermore, the incidence of cardiac events in low risk patients with negative troponin test taken 6 -9 h after symptoms onset is very low [30]. Given these previous findings we limited our study to those patients presenting at least 8 h from the beginning of symptoms.…”

Section: Discussionmentioning

confidence: 99%