The Value Of High-sensitivity Cardiac Troponin I For One-hour Rapid Triage Of Acute Myocardial Infarction

Objective To study the efficacy and feasibility of the one-hour rapid triage of acute myocardial infarction using high-sensitivity cardiac troponin I(hs-cTnI),and to provide the theoretical and practical basis for its clinical application.Methods According to a certain selection and exclusion criteria,105 cases of suspected AMI patients admitted to the emergency department were selected.The concentration of hs-cTnI in plasma of the patients immediately after admission(0 hour)and 1 hour after admission were measured by circulating enhanced fluorescence immunoassay.220 healthy people were selected to measure hs-cTnI concentration and to determine the cut-off value based on the 99 th percentile value.Results The cut-off value of hs-cTnI was 10.67pg/m L.Concentrations of hs-cTnI 1 hour after admission were significantly higher than the normal reference population and 0 hour(H=258.08,U=79.05?232.45,p<0.01).Concentrations of hs-cTnI 0 hour after admission were significantly higher than the normal reference population(H=258.08,U=20.06,p<0.01).0 hour baseline levels of hs-cTnI were higher in patients with AMI compared with the other final diagnoses.The prevalence of AMI increased with the rise of hs-cTnI concentration in 0 hour and 1 hour.Applying one-hour rapid triage,67% of patients could be classified as rule-out;19%,as rule-in;and 14%,as observe.The sensitivity and the negative predictive value for AMI in the rule-out zone were 90.9% and98.3%,respectively.The specificity and the positive predictive value for AMI in the rule-in zone were 91.7% and 87.5%,respectively.The area under the receiver operating characteristic curves(AUCROC)of 1 hour and 0 hour triage were 0.918 and 0.831,which the former shows a higher diagnostic value(Z=2.171,p<0.05).Over all,30-day mortality was 0%,0%,and 5% in patients classified as rule-out,observe,and rule-in,respectively.The 6-month mortality were 1.4%,6% and 10% respectively.Conclusion When used in conjunction with other clinical information including the ECG,the one-hour rapid triage can achieve 86% of patients with acute chest pain to be safely excluded or accurate diagnosis.It will shorten AMI diagnosis time,reduce mortality and misdiagnosis rate,as well as lower the cost and burden of medical care.