Dr. Slawski did point out that this observational, retrospective trial differed in many ways from the earlier-published PESIT trial that found a rate of 17% for PE among patients hospitalized for syncope.
Another common clinical dilemma – how to rule out MI in low-risk patients – was addressed in a meta-analysis looking at high-sensitivity troponin T levels in patients with negative ECGs.
In patients coming to the emergency department with a suspicion of acute coronary syndrome, investigators found just a 0.49% incidence of cardiac events in patients who had no ECG evidence of new ischemia and very-low high-sensitivity troponin T. The study looked at two proposed lower limits – less than .0005 mcg/L and less than .003 mcg/L.
Between these two levels, “Sensitivity and negative predictive values were about the same; no patients had mortality within 30 days if they met the criteria,” said Dr. Slawski. However, “You have to remember that sensitivity was below the preset consensus of 99%,” she said; the pooled sensitivity was 98.7%, with fairly high heterogeneity between studies. Also, she said, “If you’re going to use this strategy as your hospital, you have to remember that these values are specific to the assay” at your particular institution.
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