Article Figures & Data
Tables
- Table 1.
Characteristics of Study Patients and Prevalence of 2002 American College of Cardiology/American Heart Association Guideline Criteria
Finding Percent with finding (no. of patients with positive troponin-I with finding) Age (years) 57.4 ±13.6 Sex Male 53 Female 47 Subjective symptoms Chest pain 99 (7) Shortness of breath 5 (0) Syncope/near syncope 3 (0) Arm pain 2 (0) Palpitations 1 (0) Nausea 1 (0) Risk level ACC/AHA guideline Low 13 Intermediate 2 High 85 Clinical judgment High 47 Low 53 History of CAD 34 (6) History of diabetes mellitus 22 (5) Positive troponin-I within 30 days 2 (7) Rest pain 59 (5) Duration >20 minutes or increased tempo of pain 64 (6) New CP similar to previous anginal episode 15 (2) New S-T depression or bundle branch block 6 (1) T-wave inversions with CP 10 (2) New onset pulmonary edema (rales on exam) 3 (0) New mitral regurgitant murmur 3 (1) Abnormal vital signs (tachycardia, bradycardia, hypotension) 12 (2) Fixed Q-waves on ECG 12 (3) T-wave inversions in lateral leads with large R-waves 21 (4) Previous use of daily aspirin 41 (4) Normal ECG 44 (1) Reproducible chest pain 1 (0) Cocaine use 0 (0) ACC/AHA, American College of Cardiology/American Heart Association; CAD, coronary artery disease; CP, chest pain; ECG, electrocardiogram.
Risk Score Positive Troponin-I (>0.4) (n = 7) Negative Troponin-I (<0.4) (n = 379) Total (n = 386) American College of Cardiology/American Heart Association guidelines' utility to detect positive troponin-I values when grouped by high versus intermediate and low risk High risk 7 321 328 Intermediate + low risk 0 58 58 Total 7 379 386 American College of Cardiology/American Heart Association guidelines' utility to detect positive troponin-I values when grouped by high and intermediate versus low risk High + intermediate risk 7 330 337 Low risk 0 49 49 Total 7 379 386 Clinical judgment's utility to detect positive troponin-I values when grouped by high versus low risk High risk 7 199 206 Low risk 0 180 180 Total 7 379 386 - Table 3.
Comparison of American College of Cardiology/American Heart Association Guideline and Clinical Judgment Using Troponin-I for Diagnosis of Patients Having Myocardial Infarction Within 30 Days
Intervention Sensitivity Specificity Positive Likelihood Ratio Negative Likelihood Ratio PPV NPV 2002 ACC/AHA guidelines (high vs. intermediate and low risk) 1.00 (0.65–1.00) 0.15 (0.15–0.15) 1.18 (0.77–1.18) 0 (0–2.37) 0.02 (0.01–0.02) 1.0 (0.96–1.00) 2002 ACC/AHA guidelines (high and intermediate vs. low risk) 1.00 (0.65–1.00) 0.13 (0.12–0.13) 1.15 (0.75–1.15) 0 (0–2.81) 0.02 (0.01–0.02) 1.00 (0.95–1.00) Clinical judgment (high vs. low risk) 1.00 (0.65–1.00) 0.48 (0.47–0.48) 1.91 (1.22–1.91) 0 (0–0.75) 0.03 (0.02–0.03) 1.00 (0.97–1.00) Values in parentheses are 95% CI.
PPV, positive predictive value; NPV, negative predictive value.
Chart Heading Explanation Definition/Rating Sex Gender M, male F, female Age Age in years Whole numbers (1–100) DOA Date of admission mm/dd/yy DOD Date of discharge mm/dd/yy Sx Symptoms Descriptive verbage Rest pain Chest pain at rest 0 = absent 1 = present Dur/up tempo Duration of chest pain 0 = <20 min 1= >20 min Hx CAD History of coronary artery disease 0 = absent 1 = present New CP = angina New chest pain same as prior anginal symptoms 0 = absent 1 = present New STD/ BBB New ST segment depression or bundle branch block 0 = absent 1 = present TWI w/Sxs T-wave inversions with symptoms of chest pain 0 = absent 1 = present Rales Pulmonary rales on exam 0 = absent 1 = present New MR New onset mitral regurgitation murmur 0 = absent 1 = present Abnl VS Abnormal vital signs (tachycardia, bradycardia, hypotension only) 0 = absent 1 = present Prior ASA Prior use of daily aspirin 0 = absent 1 = present DM History of diabetes mellitus 0 = absent 1 = present Fixed QW Fixed Q-wave on electrocardiogram 0 = absent 1 = present Nml EKG Normal electrocardiogram 0 = absent 1 = present TWI/F lg R T-wave inversions or flattening in lateral leads with large R-waves 0 = absent 1 = present Repro CP Reproducible chest pain 0 = absent 1 = present Cocaine use History of cocaine use 0 = absent 1 = present TpI 1/2/3 Troponin I: 1st, 2nd, 3rd sets 0 = absent 1 = present Add test Additional test 0 = not done 1 = negative evaluation 2 = abnormality on evaluation 3 = evidence that test was done but results not available Risk Risk score 0 = low risk 1 = moderate risk 2 = high risk Outcome Cardiac damage 0 = no cardiac damage 1 = cardiac damage
