Lindahl et al reported a simple algorithm for the diagnosis of acute myocardial infarction. This can allow for a rule-in or rule-out of many patients within 2-3 hours of arrival. The authors are from multiple institutions in Sweden, Switzerland and Spain.
Patient selection: chest pain in the Emergency Department
Parameters:
(1) troponin I at baseline in ng/L
(2) troponin I at 2 hours in ng/L
(3) difference between the 2 troponin values
difference between troponin I at 2 hours and at baseline =
= (serum troponin I at 2 hours) - (serum troponin I at baseline)
Troponin I baseline
Troponin I at 2 hours
Difference between the 2 troponins
Diagnosis
< 2 ng/L
NA
NA
rule-out
>= 100
NA
NA
rule-in
2 to 5
< 6
NA
rule out
2 to 99
NA
>=10
rule-in
2 to 99
NA
< 10
observe
The negative predictive value of the 2 rule-out nodes was 99.2/99.3%.
The positive predictive value of the 2 rule-in nodes was 88.6% (initial) and 87% (2-hour).
The observation group had 8.6 to 10.4% AMI.
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