ArticleClinical chemistry2017
High-Sensitivity Cardiac Troponin I as a Gatekeeper for Coronary Computed Tomography Angiography and Stress Testing in Patients with Acute Chest Pain.
Article in Clinical chemistry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 13 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Accuracy of Contrast Enhanced Multidetector Computed Tomography to Identify Cardiac Cause of Symptoms in Patients With Intermediate Likelihood of Acute Coronary Syndrome (ACS) - A Comparison to Standard Care
Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography
Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation.Health technology assessment (Winchester, England) · 2021Pooled it
- Agreement among high-sensitivity cardiac troponin assays and non-invasive testing, clinical outcomes, and quality-of-care outcomes based on the 2020 European Society of Cardiology Guidelines.European heart journal. Acute cardiovascular care · 2024Trial
- A patient-centric chest pain management approach utilizing a high sensitivity Troponin-I assay.Heliyon · 2024Article
- Diagnostic Role and Methods of Detection of Cardiac Troponins: An Opinion from Historical and Current Points of View.Current cardiology reviews · 2023Review
- Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part I.European heart journal. Cardiovascular Imaging · 2022Article
- [Current characteristics of methods for determining cardiac troponins and their diagnostic value: a mini-review]Revista de la Facultad de Ciencias Medicas (Cordoba, Argentina) · 2021Review
- Discordance of High-Sensitivity Troponin Assays in Patients With Suspected Acute Coronary Syndromes.Journal of the American College of Cardiology · 2021Article
- Cardiac Troponins: Contemporary Biological Data and New Methods of Determination.Vascular health and risk management · 2021Review
- All Together Now: Synthesizing Evidence-Based Protocols to Simplify and Expedite Emergency Department Evaluation of Low-Risk Patients.Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2020Article
- Non-invasive imaging of the coronary arteries.European heart journal · 2019Review
- "Ultra-sensitive" cardiac troponins: Requirements for effective implementation in clinical practice.Biochemia medica · 2018Review
- Observational
- Coronary atherosclerosis imaging by CT to improve clinical outcomes.Journal of cardiovascular computed tomographyReview
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
backgroundMost patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) undergo noninvasive cardiac testing with a low diagnostic yield. We determined whether a combination of high-sensitivity cardiac troponin I (hs-cTnI) and cardiovascular risk factors might improve selection of patients for cardiac testing.
methodsWe included patients from the Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography (ROMICAT) I and II trials who presented to the ED with acute chest pain and were referred for cardiac testing. Based on serial hs-cTnI measurements and cardiovascular risk factors, we derived and validated the criterion for no need of cardiac testing. We predicted the effect of this criterion on the effectiveness of patient management.
resultsA combination of baseline hs-cTnI (<4 ng/L) and cardiovascular risk factors (<2) ruled out ACS with a negative predictive value of 100% in ROMICAT I. We validated this criterion in ROMICAT II, identifying 29% patients as not needing cardiac testing. An additional 5% of patients were identified by adding no change or a decrease between baseline and 2 h hs-cTnI as a criterion. Assuming those patients would be discharged from the ED without cardiac testing, implementation of hs-cTnI would increase ED discharge rate (24.3% to 50.2%,
conclusionsWe derived and validated a criterion for combined hs-cTnI and cardiovascular risk factors that identified acute chest pain patients with no need for cardiac testing and could improve effectiveness of patient management. ClinicalTrials.gov Identifiers: NCT00990262 and NCT01084239.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.