Usefulness of a 2-hour Delta Troponin-I During the ED Identification and Exclusion of Acute Myocardial Infarction

Launched by CHATTANOOGA-HAMILTON COUNTY HOSPITAL AUTHORITY · Dec 5, 2013

Keywords

ClinConnect Summary

Primary Aims: 1) Demonstrate that a 2hr delta troponin as measured by the i-STAT platform can reliably identify and exclude MI on the initial ED evaluation. 2)Demonstrate that a 2hr delta troponin is useful in the discrimination AMI versus non-AMI conditions in patients with low abnormal baseline Troponin-I values.

Secondary Aims: 1) Demonstrate that a positive 2-hr delta troponin-I identifies patients at highest risk for 30 day ACE. 2) Other Secondary aims TBD.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Adult patients 18 years of age or older
• • 2. Chest pain suspicious for ACS
• • 3. Absence of ST-segment elevation AMI (STEMI) or STEMI equivalent on the initial ECG
• • 4. Baseline i-STAT troponin less or equal to 1.0 ng/ml
• • 5. Enrollment initiated before 2 hour 'delt' troponin value available for review
• • 6. Ability and willingness to participate and cooperate with telephone follow-up evaluations
• Exclusion Criteria:
• • 1. ST-elevation or other ECG criteria that results in the diagnosis of AMI and results in patient being sent for percutaneous coronary interventions (PCI) or being treated with thrombolytics
• • 2. Patients with chest pain not deemed to warrant cardiac screening
• • 3. Blunt chest trauma
• • 4. Tachyarrhythmia (ventricular tachycardia, supraventricular tachycardia, or rapid atrial fibrillation)
• • 5. Cardiac Arrest prior to arrival
• • 6. Hemodynamically unstable patients
• • 7. Pulmonary edema requiring CPAP, BIPAP, or mechanical ventilation
• • 8. Baseline i-STAT troponin measurement greater than 1.0 ng/ml
• • 9. Baseline and 2-hour i-STAT Troponin measurements not obtained
• • 10. Patient (or Legal Representative) unable or unwilling to provide written informed consent
• • 11. Subject unwilling or unlikely to comply with study procedures, including protocol-specific blood sampling
• • 12. Subject unwilling, unable, or deemed unlikely to respond or participate in telephone follow-up
• • 13. Vulnerable populations as deemed inappropriate for the study