Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction
OBJECTIVE: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction.
METHODS AND RESULTS: All prehospital emergency medical service vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction. During the study period, 1 June 2012-30 November 2015, prehospital point-of-care cardiac troponin T measurements were performed in a total of 19,615 cases seen by the emergency medical service and 18,712 point-of-care cardiac troponin T measurements in 15,781 individuals were matched with an admission. A final diagnosis of acute myocardial infarction was confirmed in 2187 cases and a total of 2150 point-of-care cardiac troponin T measurements (11.0%) had a value ≥50 ng/l, including 966 with acute myocardial infarction (sensitivity: 44.2%, specificity: 92.8%). Patients presenting with a prehospital point-of-care cardiac troponin T value ≥50 ng/l had a one-year mortality of 24% compared with 4.8% in those with values <50 ng/l, log-rank: p<0.001. The following variables showed the strongest association with mortality in multivariable analysis: point-of-care cardiac troponin T≥50 ng/l (hazard ratio 2.10, 95% confidence interval: 1.90-2.33), congestive heart failure (hazard ratio 1.93, 95% confidence interval: 1.74-2.14), diabetes mellitus (hazard ratio 1.42, 95% confidence interval: 1.27-1.59) and age, one-year increase (hazard ratio 1.08, 95% confidence interval: 1.08-1.09).
CONCLUSIONS: Patients with suspected acute myocardial infarction and a prehospital point-of-care cardiac troponin T ≥50 ng/l have a poor prognosis irrespective of the final diagnosis. Routine troponin measurement in the prehospital setting has a high predictive value and can be used to identify high-risk patients even before hospital arrival so that they may be re-routed directly for advanced care at an invasive centre.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2019 |
|---|---|
| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
|---|---|
| Enthalten in: |
European heart journal. Acute cardiovascular care - 8(2019), 4 vom: 27. Juni, Seite 299-308 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Rasmussen, Martin B [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Acute myocardial infarction |
|---|
| Anmerkungen: |
Date Completed 17.12.2019 Date Revised 08.04.2022 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1177/2048872617745893 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM278648428 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM278648428 | ||
| 003 | DE-627 | ||
| 005 | 20231225021107.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2019 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1177/2048872617745893 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n0928.xml |
| 035 | |a (DE-627)NLM278648428 | ||
| 035 | |a (NLM)29199427 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Rasmussen, Martin B |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predictive value of routine point-of-care cardiac troponin T measurement for prehospital diagnosis and risk-stratification in patients with suspected acute myocardial infarction |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 17.12.2019 | ||
| 500 | |a Date Revised 08.04.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: The purpose of this study was to determine the predictive value of routine prehospital point-of-care cardiac troponin T measurement for diagnosis and risk stratification of patients with suspected acute myocardial infarction | ||
| 520 | |a METHODS AND RESULTS: All prehospital emergency medical service vehicles in the Central Denmark Region were equipped with a point-of-care cardiac troponin T device (Roche Cobas h232) for routine use in all patients with a suspected acute myocardial infarction. During the study period, 1 June 2012-30 November 2015, prehospital point-of-care cardiac troponin T measurements were performed in a total of 19,615 cases seen by the emergency medical service and 18,712 point-of-care cardiac troponin T measurements in 15,781 individuals were matched with an admission. A final diagnosis of acute myocardial infarction was confirmed in 2187 cases and a total of 2150 point-of-care cardiac troponin T measurements (11.0%) had a value ≥50 ng/l, including 966 with acute myocardial infarction (sensitivity: 44.2%, specificity: 92.8%). Patients presenting with a prehospital point-of-care cardiac troponin T value ≥50 ng/l had a one-year mortality of 24% compared with 4.8% in those with values <50 ng/l, log-rank: p<0.001. The following variables showed the strongest association with mortality in multivariable analysis: point-of-care cardiac troponin T≥50 ng/l (hazard ratio 2.10, 95% confidence interval: 1.90-2.33), congestive heart failure (hazard ratio 1.93, 95% confidence interval: 1.74-2.14), diabetes mellitus (hazard ratio 1.42, 95% confidence interval: 1.27-1.59) and age, one-year increase (hazard ratio 1.08, 95% confidence interval: 1.08-1.09) | ||
| 520 | |a CONCLUSIONS: Patients with suspected acute myocardial infarction and a prehospital point-of-care cardiac troponin T ≥50 ng/l have a poor prognosis irrespective of the final diagnosis. Routine troponin measurement in the prehospital setting has a high predictive value and can be used to identify high-risk patients even before hospital arrival so that they may be re-routed directly for advanced care at an invasive centre | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Acute myocardial infarction | |
| 650 | 4 | |a cardiac troponin | |
| 650 | 4 | |a emergency medical services | |
| 650 | 4 | |a point-of-care | |
| 650 | 4 | |a prehospital triage/methods | |
| 650 | 7 | |a Biomarkers |2 NLM | |
| 650 | 7 | |a Troponin T |2 NLM | |
| 700 | 1 | |a Stengaard, Carsten |e verfasserin |4 aut | |
| 700 | 1 | |a Sørensen, Jacob T |e verfasserin |4 aut | |
| 700 | 1 | |a Riddervold, Ingunn S |e verfasserin |4 aut | |
| 700 | 1 | |a Hansen, Troels M |e verfasserin |4 aut | |
| 700 | 1 | |a Giebner, Matthias |e verfasserin |4 aut | |
| 700 | 1 | |a Rasmussen, Claus-Henrik |e verfasserin |4 aut | |
| 700 | 1 | |a Bøtker, Hans E |e verfasserin |4 aut | |
| 700 | 1 | |a Terkelsen, Christian J |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t European heart journal. Acute cardiovascular care |d 2012 |g 8(2019), 4 vom: 27. Juni, Seite 299-308 |w (DE-627)NLM230912656 |x 2048-8734 |7 nnns |
| 773 | 1 | 8 | |g volume:8 |g year:2019 |g number:4 |g day:27 |g month:06 |g pages:299-308 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1177/2048872617745893 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 8 |j 2019 |e 4 |b 27 |c 06 |h 299-308 | ||