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Does a Negative Troponin -I Add any
Value to a Negative Stress
Echocardiogram in Patients with
Chest Pain and Intermediate Risk of
Coronary Artery Disease
Duque, Hugo; Villarraga, Héctor R.;
Rosso, Fernando; Badiel, Marisol;
Sánchez, Jairo; Olaya, Pastor
Echocardiographic and Hemodinamic Laboratory.
Fundación Valle del Lili, Cali, Colombia
Introduction: Patients with chest pain intermediate risk of coronary artery disease (CAD) are an important percentage of number consults to an emergency department (ED). In the majority of centers these patients are screened in a non-invasive manner with stress echocardiography (SE) or nuclear medicine. The incremental value of a troponin-I (TI) measurement has not been studied. We sought to evaluate the added incremental value of a TI measurement in patients with intermediate risk of CAD in the ED, at one year of follow up, compared to SE alone and TI alone.
Design: Observational. Prospective cohort.
Methods: Between June-august 1999, patients who consulted to the ED with chest pain and intermediate risk of CAD where evaluated with stress echocardiography and/or TI. Standard protocol of exercise or dobutamine stress echocardiography was performed. Blood samples for TI was taken at the ED. Follow up was done by a physician and status regarding dead or alive and hospitalization for CAD was evaluated.
Results: A total of 84 patients were followed to 1 year. 60.7% men. Age mean was 55.5 ±12.7 years. Comparison of TI alone, SE alone and TI and SE were done. The specificity, sensitivity, predictive value positive and negative are respectively 87%, 25%, 33% and 81.3% for TI alone; 84% 80%, 52% and 95% for SE alone; and 85%, 100%, 60% and 100% for SE and TI.
Conclusion: In this type of patients the combination of TI and SE allows a better prognostic tool than TI alone and SE alone, giving 100% confidence level when discharging the patient at one year follow up.
2nd Virtual Congress of Cardiology
Dr. Florencio Garófalo
Dr. Raúl Bretal
Dr. Armando Pacher
Technical Committee - CETIFAC
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