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J Korean Soc Emerg Med > Volume 29(2); 2018 > Article
Journal of The Korean Society of Emergency Medicine 2018;29(2): 204-211.
응급실에 방문한 급성심근경색 의심환자에게서 고감도 심장성 Troponin-T를 이용한 진단검사의 정확성 평가
장성주 , 박주옥 , 왕순주 , 이정아 , 박항아
한림대학교 의과대학 동탄성심병원 응급의학과
Accuracy of high-sensitivity troponin-T in patients visited emergency department with or without symptoms suggestive of acute myocardial infarction
Seong Ju Jang , Ju Ok Park , Soon Joo Wang , Choung Ah Lee , Hang A Park
Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
Correspondence  Ju Ok Park ,Tel: 031-8060-2119, Fax: 031-8086-2603, Email: juok.park@gmail.com,
Received: July 1, 2017; Revised: July 3, 2017   Accepted: October 13, 2017.  Published online: April 30, 2018.
ABSTRACT
Objective:
A method of early diagnosis of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin-T (hs-TnT) has been introduced. This study was conducted to evaluate the accuracy of hs-TnT in patients with suspected AMI.
Method:
Patients who were more than 20 years old with symptoms of AMI and who underwent hs-TnT and coronary angiography or echocardiography were included. Risk factors associated with AMI and basic characteristics were collected. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were evaluated. The effects of time from symptom onset to emergency department (ED) visit on test accuracy were analyzed.
Results:
The final analysis included 102 patients, of which 37 were AMI. The sensitivity and specificity of the hs-TnT was 59.5% (95% confidence interval [CI], 42.1% to 75.2%) and 67.7% (95% CI, 54.9% to 78.8%), respectively. In patients with typical chest pain, the sensitivity and specificity of the hs-TnT was 58.1% (95% CI, 39.1% to 75.5%) and 73.2% (95% CI, 57.1% to 85.8%), respectively. The NPV and sensitivity increased, and the PPV and specificity decreased as time from symptom onset to ED visit increased.
Conclusion:
The accuracy of the hs-TnT test was not as good in patients who visited the ED for symptoms suggestive of AMI. Therefore, to rule-in or rule-out AMI by using hs-TnT in ED, it is necessary to consider the electrocardiogram and clinical features, or to check variations by repeated measurement of hs-TnT.
Key words: Myocardial infarction; Troponin; Sensitivity and specificity; Emergency service; Hospital; Chest pain
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