Hs-troponin and prognosis
1 28. Shah ASV, Anand A, Sandoval Y, et al. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Lancet 2015; 386:2481.
2 29. Sandoval Y, Smith SW,Love SA, et al. Single high-sensitivity troponin I to rule out acute myocardial infarction. Am J Med 2017; 130 (9): 1076–1083 (UTOPIA).
3 30. Than M, Cullen L, Aldous S, et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol 2012; 59: 2091–8. Even with standard troponin assay, an undetectable troponin level < 0.01 ng/ml is associated with a very low risk of events at 30 days.
4 31. Fox KA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 2006; 333: 1091.
5 32. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem? Circulation 2013; 127: 2452–7.
Peri-PCI MI
1 33. Prasad A, Gersh BJ, Bertrand ME, et al. Prognostic significance of periprocedural versus spontaneously occurring myocardial infarction after percutaneous coronary intervention in patients with acute coronary syndromes. An analysis from the ACUITY trial. J Am Coll Cardiol 2009; 54: 477–86.
2 34 Moussa ID, Klein LW, Shah B, et al. Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization. J Am Coll Cardiol 2013; 62: 1563–70.
Zero flow LVEDP
1 35. Spaan JAE, Piek JJ, Hoffman JIE, Siebes M. Physiological basis of clinically used coronary hemodynamic indices. Circulation 2006; 113: 446–55.
Clinical approach
1 36 Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes. J Am Coll Cardiol 2014; 64: e139–228. Note, also, that 2007 AHA/ACC guidelines are relevant: J Am Coll Cardiol 2007; 50: 1–157.
2 37. Lee TH, Cook F, Weisberg M, et al. Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med 1985; 145: 65.
3 38. Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA 2005; 294: 2623–9.
ECG
1 39. Fesmire FM, Percy RF, Wears RL, et al. Risk stratification according to the initial electrocardiogram in patients with suspected acute myocardial infarction. Arch Intern Med. 1989; 149:1294–7.
2 40. Fesmire FM, Percy RF, Bardoner JB, et al. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain. Ann Emerg Med 1998; 31: 3.
3 41. Pope JH, Ruthazer R, Beshansky JR, et al. Clinical features of emergency department patients presenting with symptoms suggestive of acute cardiac ischemia: a multicenter study. J Thromb Thrombolysis 1998; 6: 63.
4 42. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med 2000; 342: 1163–70. Among patients considered normal or non-specific ECG, 2% are eventually diagnosed with MI within 30 d (~75% of which are non-Q MI) and 2% unstable angina (mainly on 1–3 d follow-up visit; prospective analysis). Troponin was not used, just ECG and CK-MB.
5 43. Krishnaswamy A, Lincoff AM, Menon V. Magnitude and consequences of missing the acute infarct-related circumflex artery. Am Heart J 2009; 158: 706–12.
6 44. Gibson C, Pride YB, Mohanavelu S, et al. Angiographic and clinical outcomes among patients with acute coronary syndrome presenting with isolated anterior ST-segment depressions. Circulation 2008; 118: S-654. Abstract 1999.
7 45. Chapman AR, Adamson PD, Mills NL. Assessment and classification of patients with myocardial injury and infarction in clinical practice. Heart 2017; 103:10–18. 0/3-hour hs-troponin protocol: single undetectable hs-troponin is enough to rule out MI if patient presents>2 hours after pain onset.
8 46. Ioannidis JPA, Salem D, Chew PW, et al. Accuracy of imaging technologies in the diagnosis of acute cardiac ischemia in the emergency department: a meta- analysis. Ann Emerg Med 2001; 37: 471–7. + Shiran A, Blondheim DS, Shimoni S, et al. Two-dimensional strain echocardiography for diagnosing chest pain in the emergency room: a multicentre prospective study by the Israeli echo research group. Eur Heart J Cardiovasc Imaging. 2017 Sep 1;18(9):1016-1024
Undetectable hs-troponin and hs-troponin algorithms (+references 28-30 and 45)
1 47. Chapman AR, Hesse K, Andrews J, et al. High-sensitivity cardiac troponin I and clinical risk scores in patients with suspected acute coronary syndrome. Circulation 2018; 138:1654-65. +Also: Modified HEART score and hs-troponin in suspected acute myocardial infarction. JACC 2019; 73: 873
2 48.Chapman AR, Anand A, Boeddinghaus J. Comparison of the efficacy and safety of early rule-out pathways for acute myocardial infarction. Circulation 2017; 135(17):1586–1596. This study validates the 0/3hr delta algorithm of reference 45 and 49, called High STEAS algorithm: negative predictive value 99.5% for MI, 100% for death (4 missed cases, all had detectable troponin with a delta troponin less than cutoff)
3 49. Shah ASV, Anand A, Chapman AR, et al. Measurement of cardiac troponin for exclusion of myocardial infarction—Authors’ reply. Lancet 2016; 387:2289–2291.
4 50. Bandstein N, Ljung R, Johansson M, Holzmann MJ. Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. J Am Coll Cardiol 2014; 63 (23): 2569–2578. Single admission non-detectable hs-troponin+nonischemic ECG → Negative predictive value 99.8% for MI, 100% for death.
5 51. Chapman AR, Lee KK, McAllister DA, et al. Association of high-sensitivity cardiac troponin I concentration with cardiac outcomes in patients with suspected acute coronary syndromes. JAMA 2017; 318(19):1913–1924. (Meta-analysis of undetectable hs-troponin on presentation).
6 52. Pickering JW, Than MP, Cullen L, et al. Rapid rule-out of acute myocardial infarction with a single high-sensitivity cardiac troponin T measurement below the limit of detection: a collaborative meta-analysis. Ann Intern Med 2017; 166(10):715–724.
7 53. Badertscher P, Boeddinghaus J, Twerenbold R, et al. Direct comparison of the 0/1h and 0/3h algorithms for early rule-out of acute myocardial infarction. Circulation 2018; 137:2536–2538: 0/1 hour is superior to old protocol (using MI cutoff). High negative predictive value of 99.8%.
8 54. Sandoval Y, Nowak R, deFellipi CR, et al. Myocardial infarction risk stratification with a single measurement of troponin I. J Am Coll Cardiol 2019; 74:271–282: A single very low hs-troponin I has a 30-day negative predictive value of 99.8% for MI/death, using troponin I US assays (very low defined as <0.005 ng/ml, the detection cutoff being 0.002). It seems <0.005 ng/ml is a good rule-out cutoff in all hs-troponin assays; hs troponin does not have to be undetectable, as assays are becoming more sensitive.
