Évaluation d'une stratégie d'exclusion d'un syndrome coronarien aigu non ST+ basé sur une unique mesure de troponine de haute sensibilité à partir d'un prélèvement effectué entre 3 et 6 heures après le début de la douleur

Abstract

BackgroundGuidelines recommend to consider excluding non-ST-segment elevation myocardial infarction (NSTEMI) when high-sensitivity cardiac troponin is below the limit of quantification and a single blood sample is taken > 6 h after the onset of chest pain. The aim of our study was to assess such exclusion when a single blood sample was taken 3–6 h after the onset of permanent chest pain. MethodsThis observational study included consecutive patients admitted into the emergency room of our hospital with chest pain and suspected NSTEMI, with non-contributive electrocardiograms and a single high-sensitivity cardiac troponin I (hs-cTnI) blood sample taken 3–6 h after the onset of chest pain and hs-cTnI < 4 ng/l (Abbott Diagnostic). Clinical follow-up was undertaken 1 month after admission. ResultsThe mean age of the 432 patients was 48.5 ± 5.6 years and 51% were male. Based on a clinical algorithm, the pre-test probability of NSTEMI was low in 70%, and intermediate in 21% of patients. Among 419 patients with available 1-month follow-up data, there were no myocardial infarctions or deaths. Thirty-eight patients (9%) were admitted into hospital but none for cardiac reasons. ConclusionsOur results suggest that exclusion of NSTEMI in patients with a non-contributive electrocardiogram and a single “negative” troponin test in a blood sample taken 3–6 h after the onset of symptoms is valid.