Changes in troponin for diagnosis of acute myocardial infarction (AMI) in an emergency department (ED) population with chest pain.

In an Australian representative sample of patients presenting to an emergency department with chest pain, what delta troponin (TnI) value (percentage increase in TnI) has the greatest diagnostic accuracy to rule in acute myocardial infarction (AMI), either alone or in combination with the 99th percentile decision limit, at 0-2 hours and 0-6 hours after presentation using the Beckman Coulter Access AccuTnI assay?

Status

Completed

Phases

Unknown

Study type

Observational

Source

ANZCTR

Registry ID

ACTRN12610000052033

Enrollment

650

Registered

2010-01-18

Start date

2008-10-29

Completion date

2011-02-04

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

The current process for diagnosing heart attack (acute myocardial infarction; AMI) is to take multiple blood tests to measure cardiac troponin. The current definition for AMI requires troponin levels to be elevated (greater than the 99th percentile of a reference population) and to display a rising or falling pattern. However, this definition remains controversial as there is no clearly defined, evidence based data for how much the troponin level should change. We aim to identify what change in troponin value (percentage increase in troponin) has the greatest diagnostic accuracy for diagnosis of AMI. We will focus on the change in combination with the 99th percentile decision limit, at 0-2 hours and 0-6 hours after presentation using the Beckman Coulter Access AccuTnI assay.

Interventions

The current definition for AMI with the emphasis on the requirement for troponin elevations to be greater than the 99th percentile of a reference population in combination with a rising or falling pattern remains controversial. At present, there is no clearly defined, evidence based value for delta TnI. We aim to identify what delta TnI value (percentage increase in TnI) has the greatest diagnostic accuracy to rule in AMI, either alone or in combination with the 99th percentile decision limit,

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

Inclusion criteria include all patients who present to the emergency departmetn (ED)with at least 5 minutes of chest pain suggestive of acute coroanry syndrome (ACS). In accord with American Heart Association (AHA) guidelines, these will include the presence of acute chest, epigastric, neck, jaw or arm pain or discomfort or pressure or breathlessness without apparent non-cardiac source. More general/atypical symptoms (such as fatigue, nausea, vomiting, sweating and faintness) will not be used as inclusion criteria. Patients who have chest discomfort and in whom the attending staff consider it necessary to perform an Electrocardiogram (ECG) for the assessment of possible ACS will be enrolled.

Exclusion criteria

Pregnancy Patients under the age of 18 years old Unable or unwilling to consent Patients for whom follow-up will not be possible either due to lack of contact address or because they will be overseas.

Outcome results