Positive predictive value of an elevated cardiac troponin for type i myocardial infarction in ED patients based on the chief complaint

Ronald L. Maag, Susie Sun, Michael Hannon, Rhian Davies, Peter Alagona, Andrew Foy

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Cardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described. The objective of this study was to determine the PPV of an elevated troponin for type I MI based on the ED chief complaint. Methods We retrospectively reviewed the medical records of 1772 consecutive patients who had a troponin ordered in the ED at a tertiary care center over the period of March 1, 2013, to April 30, 2013. The chief complaint was based on official ED coding. For patients with a positive troponin, 2 authors independently reviewed the electronic medical record pertaining to the index encounter and subsequent hospitalization to adjudicate the cause. Results There was a significant association between the PPV of an elevated troponin for type I MI and the chief complaint. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 84% vs 20%; Adjusted Odds Ratio (AOR), 14.31; P <.0001). There was also a significant association between the rate of type I MI and the chief complaint in all patients who had a troponin drawn. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 9.8% vs 1.3%; AOR, 7.34; P <.0001). Conclusion Applying information on the PPV of troponin for type I MI based on the clinical history could improve troponin utilization and clinical decision making.

Original languageEnglish (US)
Pages (from-to)516-520
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume33
Issue number4
DOIs
StatePublished - Apr 1 2015

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Troponin
Hospital Emergency Service
Myocardial Infarction
Troponin I
Chest Pain
Odds Ratio
Coronary Thrombosis
Electronic Health Records
Tertiary Care Centers
Medical Records
Coronary Vessels
Hospitalization

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

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title = "Positive predictive value of an elevated cardiac troponin for type i myocardial infarction in ED patients based on the chief complaint",
abstract = "Background Cardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described. The objective of this study was to determine the PPV of an elevated troponin for type I MI based on the ED chief complaint. Methods We retrospectively reviewed the medical records of 1772 consecutive patients who had a troponin ordered in the ED at a tertiary care center over the period of March 1, 2013, to April 30, 2013. The chief complaint was based on official ED coding. For patients with a positive troponin, 2 authors independently reviewed the electronic medical record pertaining to the index encounter and subsequent hospitalization to adjudicate the cause. Results There was a significant association between the PPV of an elevated troponin for type I MI and the chief complaint. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 84{\%} vs 20{\%}; Adjusted Odds Ratio (AOR), 14.31; P <.0001). There was also a significant association between the rate of type I MI and the chief complaint in all patients who had a troponin drawn. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 9.8{\%} vs 1.3{\%}; AOR, 7.34; P <.0001). Conclusion Applying information on the PPV of troponin for type I MI based on the clinical history could improve troponin utilization and clinical decision making.",
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Positive predictive value of an elevated cardiac troponin for type i myocardial infarction in ED patients based on the chief complaint. / Maag, Ronald L.; Sun, Susie; Hannon, Michael; Davies, Rhian; Alagona, Peter; Foy, Andrew.

In: American Journal of Emergency Medicine, Vol. 33, No. 4, 01.04.2015, p. 516-520.

Research output: Contribution to journalArticle

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T1 - Positive predictive value of an elevated cardiac troponin for type i myocardial infarction in ED patients based on the chief complaint

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AU - Sun, Susie

AU - Hannon, Michael

AU - Davies, Rhian

AU - Alagona, Peter

AU - Foy, Andrew

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N2 - Background Cardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described. The objective of this study was to determine the PPV of an elevated troponin for type I MI based on the ED chief complaint. Methods We retrospectively reviewed the medical records of 1772 consecutive patients who had a troponin ordered in the ED at a tertiary care center over the period of March 1, 2013, to April 30, 2013. The chief complaint was based on official ED coding. For patients with a positive troponin, 2 authors independently reviewed the electronic medical record pertaining to the index encounter and subsequent hospitalization to adjudicate the cause. Results There was a significant association between the PPV of an elevated troponin for type I MI and the chief complaint. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 84% vs 20%; Adjusted Odds Ratio (AOR), 14.31; P <.0001). There was also a significant association between the rate of type I MI and the chief complaint in all patients who had a troponin drawn. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 9.8% vs 1.3%; AOR, 7.34; P <.0001). Conclusion Applying information on the PPV of troponin for type I MI based on the clinical history could improve troponin utilization and clinical decision making.

AB - Background Cardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described. The objective of this study was to determine the PPV of an elevated troponin for type I MI based on the ED chief complaint. Methods We retrospectively reviewed the medical records of 1772 consecutive patients who had a troponin ordered in the ED at a tertiary care center over the period of March 1, 2013, to April 30, 2013. The chief complaint was based on official ED coding. For patients with a positive troponin, 2 authors independently reviewed the electronic medical record pertaining to the index encounter and subsequent hospitalization to adjudicate the cause. Results There was a significant association between the PPV of an elevated troponin for type I MI and the chief complaint. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 84% vs 20%; Adjusted Odds Ratio (AOR), 14.31; P <.0001). There was also a significant association between the rate of type I MI and the chief complaint in all patients who had a troponin drawn. Patients with a chief complaint of chest pain were significantly more likely to have a type I MI compared to those without (PPV 9.8% vs 1.3%; AOR, 7.34; P <.0001). Conclusion Applying information on the PPV of troponin for type I MI based on the clinical history could improve troponin utilization and clinical decision making.

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