000			02965nam a22003737a 4500
008			221018s20222022 xxu||||| |||| 00| 0 eng d
022			_a0735-6757
024			_a10.1016/j.ajem.2022.08.037 [doi]
024			_aS0735-6757(22)00540-X [pii]
040			_aOvid MEDLINE(R)
099			_a36041277
245			_aHigh sensitivity troponin - Six hours is the magic number.
251			_aAmerican Journal of Emergency Medicine. 61:52-55, 2022 Aug 19.
252			_aAm J Emerg Med. 61:52-55, 2022 Aug 19.
253			_aThe American journal of emergency medicine
260			_c2022
260			_fFY2023
260			_p2022 Aug 19
265			_saheadofprint
266			_d2022-10-20
520			_aBACKGROUND: High sensitivity troponin assays have become widespread for emergency department evaluation of acute chest pain. We assessed if a high sensitivity troponin under the 99th percentile upper reference limit drawn at 6 h or greater from symptom onset could safely rule out acute coronary syndrome in patients who did not meet the rapid rule-out strategy.
520			_aCONCLUSION: This study assessed patients with chest pain with high sensitivity troponin values between 3 ng/L and the 99th percentile upper reference limit after 6 h of chest pain and found that they have a low rate of clinically relevant adverse cardiac events and NSTEMI. Copyright © 2022 Elsevier Inc. All rights reserved.
520			_aMETHODS: We conducted a multicenter retrospective study examining emergency department patients with chest pain who did not meet rapid-rule out criteria and were admitted for further evaluation. Among these admitted patients, we assessed the rate of clinically relevant adverse cardiac events (death, cardiac or respiratory arrest, STEMI, or life-threatening arrhythmia) and NSTEMI in patients with high sensitivity troponin less than the 99th percentile value obtained after at least 6 h of chest pain.
520			_aRESULTS: Out of 1187 patients admitted, we found 30 clinically relevant adverse cardiac events, all of which occurred in patients admitted for another compelling reason or ischemic ECG. 36 patients had an NSTEMI, of which 33 were identified with high sensitivity troponin greater than 99th percentile upper reference limit within 6 h of chest pain onset. This left 0 clinically relevant adverse cardiac events and 3 NSTEMI among the 429 patients with high sensitivity troponin less than the 99th percentile at 6 h and nonischemic ECG and no other compelling reason for admission.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aEmergency Medicine
657			_aJournal Article
700			_aSpiegel, Rory _bMWHC
790			_aBhat RG, Blue O, Cacciapuoti M, Harvey H, Nguyen MV, Spiegel R, Thai HT
856			_uhttps://dx.doi.org/10.1016/j.ajem.2022.08.037 _zhttps://dx.doi.org/10.1016/j.ajem.2022.08.037
942			_cART _dArticle
999			_c279 _d279