Fast-track high-sensitive cardiac troponin T algorithm for diagnosis of non-ST-elevation myocardial infarction in older patients at the emergency department

摘要: Purpose: Age >70 years is an independent factor associated with elevated high-sensitivity troponin T (hs-cTnT) values in Emergency Department (ED) patients. We examined whether algorithm implementing a serial hs-cTnT measurement at presentation (0h) and 3h after (3h) helpful for early diagnosis of non-ST-elevation myocardial infarction (NSTEMI) older patients. Methods: Consecutive unselected patients ≥70 presenting to our ED were enrolled prospective diagnostic study. The final NSTEMI was adjudicated by two cardiologists rule-in rule-out developed using classification regression tree analysis. Results: Among 306 (mean age 81±6 years), 38 (12%) had NSTEMI. Accuracy diagnose significantly higher measurements vs. 0h (area under the receiver operating characteristic curve (AUC) 0.88 0.82, p=0.0038) absolute relative delta changes (AUC 0.89 0.69, p<0.001). A ruled-in 23% ruled-out 35% For neither fulfilling nor criteria, observational zone established. Cumulative 1-year survival 79.4%, 88.5% 99.1% classified as rule-in, rule-out, respectively. Conclusions: In delta-changes valuable An one quarter high risk third low risk.