[Risk stratification and role for additional diagnostic testing in patients with acute chest pain and normal high-sensitivity cardiac troponin levels].

Autor:	Smulders MW; Maastricht UMC+, afd. Cardiologie., Bekkers SCAM; Maastricht UMC+, afd. Cardiologie., van Cauteren YJM; Maastricht UMC+, afd. Cardiologie., Liefhebber A; Maastricht UMC+, afd. Cardiologie., Vermeer JR; Maastricht UMC+, afd. Cardiologie., Vervuurt J; Maastricht UMC+, afd. Cardiologie., van Dieijen-Visser MP; Maastricht UMC+, Centraal Diagnostisch Laboratorium., Mingels AMA; Maastricht UMC+, Centraal Diagnostisch Laboratorium., Brunner-La Rocca HP; Maastricht UMC+, afd. Cardiologie., Dagnelie PC; Maastricht UMC+, afd. Epidemiologie., Wildberger JE; Maastricht UMC+, afd. Radiologie., Crijns HJGM; Maastricht UMC+, afd. Cardiologie., Kietselaer BLJH; Maastricht UMC+, afd. Cardiologie.; Contact: B.L.J.H. Kietselaer (b.kietselaer@zuyderland.nl).
Jazyk:	Dutch; Flemish
Zdroj:	Nederlands tijdschrift voor geneeskunde [Ned Tijdschr Geneeskd] 2018 Dec 05; Vol. 162. Date of Electronic Publication: 2018 Dec 05.
Abstrakt:	Background: Normal high sensitivity cardiac troponin (hs-cTn) assays rule out acute myocardial infarction (AMI) with great accuracy, but additional non-invasive testing is frequently ordered. This observational study evaluates whether clinical characteristics can contribute to risk stratification and could guide referral for additional testing. Methods: This observational study included 918 patients with acute chest pain and normal hs-cTnT values. Major adverse cardiac events (MACE) and non-invasive test results were assessed during one-year follow-up. Patients were classified as low and high risk based on clinical characteristics. Results: In total, 6,4% of patients experienced MACE during follow-up and mainly comprised revascularisations (86%). Absence of both recent abnormal stress test and suspicious history identified 86% of patients. These patients were at very low risk for MACE (0,4% in 30-days). Despite this, the majority (287/345=83%) of additional tests were performed in low risk patients, with 8% abnormal test findings (positive predictive value for MACE was 17%). The diagnostic yield was significantly higher in the remaining higher risk patients, 40% abnormal test findings and a positive predictive value of 70% for MACE. Conclusion: Clinical characteristics can be used to identify low risk patients with acute chest pain and normal hs-cTnT levels. Current strategies in the emergency department result in numerous additional tests, which are mostly ordered in patients at very low risk and have a low diagnostic yield.
Databáze:	MEDLINE
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