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Nguyen Nguyen , 4 th year Pharmd candidate, University of georgia Preceptor: Dr. Ali Rahimi

Implementation of a Sensitive Troponin I Assay and Risk of Recurrent Myocardial Infarction and Death in Patients With Suspected Acute Coronary Syndrome. Nguyen Nguyen , 4 th year Pharmd candidate, University of georgia Preceptor: Dr. Ali Rahimi. Level of evidence.

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Nguyen Nguyen , 4 th year Pharmd candidate, University of georgia Preceptor: Dr. Ali Rahimi

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  1. Implementation of a Sensitive Troponin I Assay and Risk of Recurrent Myocardial Infarction and Death in Patients With Suspected Acute Coronary Syndrome Nguyen Nguyen, 4th year Pharmd candidate, University of georgiaPreceptor: Dr. Ali Rahimi

  2. Level of evidence

  3. Increasing the sensitivity of troponin assay can improve early diagnosis of myocardial infarction Only values at or above the diagnostic threshold of 0.20 ng/mL Provide assess to better intervention for patients with suspected acute coronary syndrome Background

  4. Determine the effect of sensitive assay on the rate diagnosis of MI Whether small increases in troponin predict the future risk of adverse clinical outcomes How lowering the diagnostic thresholds would affect clinical outcomes Background

  5. Original diagnostic threshold was 0.20 ng/mL with laboratory coefficient of variation of <10% Assay was reformulated to achieve a greater analytical sensitivity of 0.01 ng/mL Background

  6. Patients who were admitted with suspected ACS to Royal Infirmary of Edinburgh • Validation period: February 1 to July 31, 2008 • Only concentrations above the original diagnostic threshold >= 0.20 ng/mL were reported • Implementation period: February 1 to July 31, 2010 • Concentrations above >= 0.05 ng/mL were reported in the implementation phase Design and Setting

  7. 3434 patients met the inclusion criteria but 1342 patients had at least 1 exclusion criteria • Total study population was 2092 patients • Inclusion criteria: • Symptoms of chest pain of suspected cardiac origin measurement of plasma troponin I concentration on admission Study population

  8. Exclusion criteria: • Noncardiac chest pains • Tachyarrhythmia • Anemia • Severe valvular heart disease • Pericarditis • Cocaine use Study population

  9. results

  10. results

  11. results

  12. The increase sensitivity allowed for the detection of MI by 29% • Identified patients who were at highest risk of recurrent MI and death • Lowering the diagnostic threshold allowed for 50% reduction in the rate of death or recurrent MI in the subgroup of patients • Patients are from a homogenous population Conclusion

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