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This adaptation is associated with increased agonist affinity of the beta-receptor. The present study was undertaken to evaluate if increased beta-receptor agonist affinity has a physiologic counterpart which may contribute to the remained function in hypotrophic hearts. The isolated, perfused, working rat heart was used as a model. However, since the algorithm was developed based on earlier determination, it may lack the necessary properties to determine the observational group.

To date, no studies have evaluated its use and the proportion of the observational group in Thailand. Therefore, we conducted this study to evaluate its feasibility. The proportion of the observational group in our sample was This was considered acceptable by our a priori definition of acceptable.

This proves the feasibility of this algorithm in crowded Thai ED settings. Nevertheless, further studies are necessary to estimate its cost savings. We found that the number of patients visiting the ED was highest during daytime of working day.

Cardiac stress test - Wikipedia

Although we hypothesized that ED crowding might cause a delay in the diagnostic process, the subgroup analysis with regard to period of ED visit showed no significant differences. A trend towards longer duration on daytime of working day was found in all intervals although these were not significant. This might have been because of small numbers of patients in subgroup analyses.

The laboratory processing time was longer in the pre-implementation group. This may have been caused by recent improvements in our laboratory analyzing system and process that affected the post-implementation group. Thus, the delay in the first laboratory process could have been from waiting for other blood chemistry results. If hs-cTnT had been analyzed and reported separately, the first laboratory processing time may have been similar to the second.

High-Sensitivity Cardiac Troponin in the Evaluation of Possible AMI

Patients in the pre-implementation group appeared to be more at risk of having an AMI. The differences may have been due to enrollment of controls who were matched using retrospective data collection. It might also have caused a time-related benefit for the pre-implementation group. Because of the prolonged time from the onset of chest pain to presentation, patients in this group had a higher tendency towards having highly elevated first hs-cTnT results, which would have made the diagnosis possible earlier than in the post-implementation group.

Nevertheless, the outcomes after controlling for these patient characteristic differences were not significantly different from the original values. Disposition type was also not significantly different between the two groups despite the higher admission rate in the pre-implementation group. The reasons for this high admission rate were the higher number of rule-in patients predisposed to being admitted and the higher number of rule-out patients admitted due to diagnoses other than AMI in the pre-implementation group.

The 1-h hs-cTnT algorithm showed good discrimination to rule-in and rule-out patients suspected of AMI. Nevertheless, this interpretation should be treated with caution given that each algorithm was performed on a different group of patients precluding direct comparison. This percentage was comparable to the previous trials that externally validated this algorithm [ 12 , 13 , 14 , 15 , 16 , 17 ].

This could be explained by the different outcome measure MACE vs. There were many limitations in this study. First, the study design was a historical control design, which resulted in unequal patient characteristics.

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Although we controlled these in multivariable analysis, further studies properly matching by risk stratification should still be performed. Secondly, the sample size may have been too small to determine the effect of ED crowding. A further study with a large sample size may find a significant difference. Finally, this study was a single-centered study in a major university hospital tertiary care center.

Thus, our findings may not be generalizable to other EDs in different Thai settings. The 1-h hs-cTnT algorithm was feasible because of the acceptable proportion in the observation group. World Health Organization. Cardiovascular diseases: fact sheet number [Internet]. Centers of Disease Control and Prevention. Global health Thailand [Internet]. How to use high-sensitivity cardiac troponins in acute cardiac care.


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Eur Heart J. Mueller C. Biomarkers and acute coronary syndromes: an update.

Elevated troponin T levels and lesion characteristics in non-ST-elevation acute coronary syndromes. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med.

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Clin Biochem. One-hour rule-in and rule-out of acute myocardial infarction using high-sensitivity cardiac troponin I. Am J Med. Early rule-out and rule-in of myocardial infarction using sensitive cardiac Troponin I.


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