Heart Attack Diagnosis in the Emergency Room: How Accurate in Cardiac Troponin?

Martin J. Holzmann, MD, PHD Department of Emergency Medicine Karolinska University Hospital, HuddingeMedicalResearch.com Interview with:
Martin J. Holzmann, MD, PHD
Department of Emergency Medicine
Karolinska University Hospital, Huddinge


MedicalResearch.com: What are the main findings of the study?

Dr. Holzmann: In a cohort of 8900 consecutive patients who sought medical attention for chest pain, we found that an undetectable high-sensitivity cardiac troponin level (<5 ng/l), and an ECG with no ischemic changes has a negative predictive value of 99.8% (95%, 99.7-99.9%). Thus, this will rule out MI with nearly 100% accuracy, and independent of when the troponin was measured in relation to onset of chest pain, and independent of any risk factors for cardiovascular disease.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Holzmann: We did not expect such a high negative predictive value. It was nearly 100%. Also, even if it was not the aim of our study, we found that there were only 2 cardiovascular deaths, among 8900 patients with undetectable hs-cTnT within 1 year of follow-up. Thus, that indicates that the baseline risk of cardiovascular disease is very, very low in this patient group.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Holzmann: Our simple strategy will be helpful when in doubt if to discharge or admit a patient from the emergency room. However, one has do make a clinical assessment since there may be other reasons for being admitted to the hospital.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Holzmann: What we really need is an intervention study where we use our strategy to rule out MI where the primary endpoint will be a reduction in hospitalizations. The secondary endpoint will be reduced waiting time in the emergency department.


Bandstein N, Ljung R, Johansson M, Holzmann MJ. Undetectable High Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction. J Am Coll Cardiol. 2014;():. doi:10.1016/j.jacc.2014.03.017.