A new study published in BMJ Open has determined the most effective criteria at presentation to emergency department (ED) to identify high-risk non-ST elevation myocardial infarction (NSTEMI).
The study recruited 1642 consecutive patients (median age, 59 years; 52% male) presenting to ED in northwest England with a primary symptom of chest pain in whom there is suspicion of NSTEMI.
The incidence of adjudicated NSTEMI was 10.7 per cent, and one-year mortality was 6.3 per cent. Independent predictors for all-cause death at one year were Global Registry of Acute Coronary Events (GRACE) >140, age (per decade increase) and high-sensitive cardiac troponin T (hs-cTnT) >50 ng/L.
hs-cTnT >50 ng/L was associated with adjudicated index presentation NSTEMI in the greatest proportion of patients (61.7%). When using major adverse cardiovascular events (MACE) at 12 months as an endpoint rather than all-cause death, history, ECG, age, risk factors and troponin (HEART) score ≥7 were included in the multivariate model and had better prediction of index NSTEMI than GRACE>140. Combining hs-cTnT >50 ng/L and a second independent predictor identified a high proportion of index NSTEMI and elevated risk of all-cause death at one year.
The authors concluded that hs-cTnT >50 ng/L or HEART score ≥7 appear to be effective strategies to identify high-risk NSTEMI at presentation to ED with chest pain. However, they add that multicentre prospective studies enriched with early presenters, and with competitor high-sensitive and point-of-care troponins, are required to validate and extend these findings.
