Evidence map›Paper›PMID 31923216›Full record

ArticlePloS one2020

Use of conventional cardiac troponin assay for diagnosis of non-ST-elevation myocardial infarction: 'The Ottawa Troponin Pathway'.

Venkatesh Thiruganasambandamoorthy, Ian G Stiell, Hina Chaudry, Muhammad Mukarram, Ronald A Booth, Cristian Toarta, Guy Hebert, Robert S Beanlands, George A Wells, Marie-Joe Nemnom and 1 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.6field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 7 citations in OpenAlex.

  1. Evaluating the performance of the HEART score in a Tanzanian emergency department.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2024
    Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Venkatesh ThiruganasambandamoorthyDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Ian G StiellDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Hina ChaudryOttawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
Muhammad MukarramOttawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
Ronald A BoothDepartment of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada.
Cristian ToartaSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Guy HebertDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Robert S BeanlandsDivision of Cardiology, University of Ottawa, Ottawa, ON, Canada.
George A WellsSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Marie-Joe NemnomOttawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.ORCID 0000-0002-0102-1984
Monica TaljaardOttawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.
University of Ottawa · CAOttawa Hospital · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSerial conventional cardiac troponin (cTn) measurements 6-9 hours apart are recommended for non-ST-elevation MI (NSTEMI) diagnosis. We sought to develop a pathway with 3-hour changes for major adverse cardiac event (MACE) identification and assess the added value of the HEART [History, Electrocardiogram (ECG), Age, Risk factors, Troponin] score to the pathway.

methodsWe prospectively enrolled adults with NSTEMI symptoms at two-large emergency departments (EDs) over 32-months. Patients with STEMI, unstable angina and one cTn were excluded. We collected baseline characteristics, Siemens Vista conventional cTnI at 0, 3 or 6-hours after ED presentation; HEART score predictors; disposition and ED length of stay (LOS). Adjudicated primary outcome was 15-day MACE (acute MI, revascularization, or death due to cardiac ischemia/unknown cause). We analyzed multiples of 99th percentile cut-off cTnI values (45, 100 and 250ng/L).

results1,683 patients (mean age 64.7 years; 55.3% female; median LOS 7-hours; 88 patients with 15-day MACE) were included. 1,346 (80.0%) patients with both cTnI≤45 ng/L; and 155 (9.2%) of the 213 patients with one value≥100ng/L but both<250ng/L or ≤20% change did not suffer MACE. Among 124 patients (7.4%) with one of the two values>45ng/L but<100ng/L based on 3 or 6-hour cTnI, one patient with absolute change<10ng/L and 6 of the 19 patients with≥20ng/L were diagnosed with NSTEMI (patients with Δ10-19ng/L between first and second cTnI had third one at 6-hours). Based on the results, we developed the Ottawa Troponin Pathway (OTP) with a 98.9% sensitivity (95% CI 93.8-100%) and 94.6% specificity (95% CI 93.3-95.6%). Addition of the HEART score improved the sensitivity to 100% (95% CI 95.9-100%) and decreased the specificity to 26.5% (95% CI 24.3-28.7%).

conclusionThe OTP with conventional cTnI 3-hours apart, should lead to better NSTEMI identification particularly those with values >99th percentile, standardize management and reduce the ED LOS.

Indexed as

AgedCohort StudiesFemaleHumansMaleMiddle AgedMyocardiumNon-ST Elevated Myocardial InfarctionPrognosisTroponin ITroponin I

Identifiers

PMID31923216
PMCPMC6953858
OpenAlexW2998796842

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.