Single hs-cTnT for triage and exclusion of acute MI

A single high-sensitivity cardiac troponin T (hs-cTnT) below the limit of quantitation (LoQ) of 6 ng/L is a safe and rapid method to traige and exclude patients who are at very low risk for acute myocardial injury and infarction, a US study has shown.

Biomarker data was evaluated from 22 centres and a total of 85,610 patients of whom 29% had a baseline hs-cTnTof less than 6 ng/L. The findings showed that women were more likely than men to have hs-cTnT below the LoQ  (38% vs. 20%, p<0.0001).

For the 11,962 patients with baseline hs-cTnT<6 ng/L and serial measurements, only 1.2% developed acute myocardial injury, resulting in a negative predictive value of 98.8% and sensitivity of 99.6%.

Among patients with a nonischaemic electrocardiogram, 33% had a baseline hs-cTnT<6 ng/L. In this group, the negative predictive value and sensitivity for acute MI were 100% and there were no missed diagnoses of acute MI.

The study investigators also noted that in the 41-44% of patients with chest pain and a baseline hs-cTnT<6 ng/L, only 0.2% had a diagnosis of acute MI the death rate was 0.03%.

The findings are published in Circulation.

Cardiologist fails in Federal election bid

Former CSANZ president Professor Michael Feneley failed in his latest bid as Liberal candidate for Federal parliament, losing out to incumbent Labor member Emma McBride in the NSW Central Coast seat of Dobell. McBride retained the seat with a 5% swing, gaining 49,725 votes, a margin of 11,210 over Professor Feneley.

The Sydney cardiologist has previously stood as Liberal candidate for the Sydney seat of Kingsford Smith, losing to Labor’s Peter Garret in 2010 and to Matt Thistlethwaite in 2013 and 2016.

The neighbouring Central Coast seat of Robertson was taken by emergency medicine specialist and Labor candidate Dr Gordon Reid who gained a 7% swing to win over the previous Liberal member, Lucy Wicks.

Most chest pain ambulance calls are not MI

Chest pain accounts for one in ten ambulance calls, according to Victorian figures which show that almost half of patients are discharged from hospital with a diagnosis of non-specific pain and have an excellent prognosis.

A retrospective review of emergency medical services (EMS) attendances for non-traumatic chest pain in Victoria between 2015 and 2019 showed that chest pain was the main reason for 257,017 of 2,736,570 (9.4%) calls to 000.

The most common diagnoses were non-specific pain (46%; 30-day mortality 0.5%), non-ST elevation myocardial infarction (5.3%; mortality 1.3%), pneumonia (3.8%; mortality 3.9%), stable coronary syndromes (3.5%; mortality 0.8%), unstable angina (3.3%; mortality 1.3%), and ST-elevation myocardial infarction (2.8%; mortality 7.0%).

Overall, a final diagnosis of myocardial infarction occurred among 8.5% of patients (11.3% for males, 5.8% for females).

Mortality was low among most patients discharged by ambulance without transport to hospital (i.e. transport determined not required or case referred to local medical services), higher mortality was observed among males aged 50-69 years (1.8%) and those over 70 (5%).

The findings are published in Annals of Epidemiology.