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Trial registered on ANZCTR
Registration number
ACTRN12610000052033
Ethics application status
Approved
Date submitted
15/01/2010
Date registered
18/01/2010
Date last updated
12/02/2014
Type of registration
Retrospectively registered
Titles & IDs
Public title
Changes in troponin for diagnosis of acute myocardial infarction (AMI) in an emergency department (ED) population with chest pain.
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Scientific title
In an Australian representative sample of patients presenting to an emergency department with chest pain, what delta troponin (TnI) value (percentage increase in TnI) has the greatest diagnostic accuracy to rule in acute myocardial infarction (AMI), either alone or in combination with the 99th percentile decision limit, at 0-2 hours and 0-6 hours after presentation using the Beckman Coulter Access AccuTnI assay?
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Secondary ID [1]
1301
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None
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Secondary ID [2]
284081
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Acute coronary syndrome
256556
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Condition category
Condition code
Cardiovascular
256724
256724
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0
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Coronary heart disease
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Intervention/exposure
Study type
Observational
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Patient registry
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Target follow-up duration
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Target follow-up type
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Description of intervention(s) / exposure
The current definition for AMI with the emphasis on the requirement for troponin elevations to be greater than the 99th percentile of a reference population in combination with a rising or falling pattern remains controversial. At present, there is no clearly defined, evidence based value for delta TnI. We aim to identify what delta TnI value (percentage increase in TnI) has the greatest diagnostic accuracy to rule in AMI, either alone or in combination with the 99th percentile decision limit, at 0-2 hours and 0-6 hours after presentation using the Beckman Coulter Access AccuTnI assay. Total period of observational trial is 1.5 years.
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Intervention code [1]
255826
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Not applicable
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Comparator / control treatment
End point adjudication by cardiologists will define the clinical outcome for patients enrolled in the trial.
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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AMI as adjudicated by cardiologists as an endpoint.
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Assessment method [1]
257611
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Timepoint [1]
257611
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Within 24 hours of presentation to ED
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Secondary outcome [1]
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Alternative diagnosis with raised TnI - as adjudicated by cardiologists.
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Assessment method [1]
262882
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Timepoint [1]
262882
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Within 24 hours of presentation to ED
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Eligibility
Key inclusion criteria
Inclusion criteria include all patients who present to the emergency departmetn (ED)with at least 5 minutes of chest pain suggestive of acute coroanry syndrome (ACS). In accord with American Heart Association (AHA) guidelines, these will include the presence of acute chest, epigastric, neck, jaw or arm pain or discomfort or pressure or breathlessness without apparent non-cardiac source. More general/atypical symptoms (such as fatigue, nausea, vomiting, sweating and faintness) will not be used as inclusion criteria.
Patients who have chest discomfort and in whom the attending staff consider it necessary to perform an Electrocardiogram (ECG) for the assessment of possible ACS will be enrolled.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Pregnancy
Patients under the age of 18 years old
Unable or unwilling to consent
Patients for whom follow-up will not be possible either due to lack of contact address or because they will be overseas.
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Study design
Purpose
Screening
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
20/10/2008
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Actual
29/10/2008
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Date of last participant enrolment
Anticipated
20/10/2010
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Actual
4/02/2011
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
650
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Funding & Sponsors
Funding source category [1]
256320
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Charities/Societies/Foundations
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Name [1]
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Queensland Emergency Medicine Research Foundation
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Address [1]
256320
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88 L'Estrange Tce
Kevin Grove
Queensland 4059
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Country [1]
256320
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Australia
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Primary sponsor type
Charities/Societies/Foundations
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Name
Queensland Emergency Medicine Research Foundation QEMRF
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Address
88 L'Estrange Tce
Kevin Grove
Queensland 4059
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Country
Australia
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Secondary sponsor category [1]
251637
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None
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Name [1]
251637
0
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Address [1]
251637
0
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Country [1]
251637
0
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
258404
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Human Research Ethics committee - Royal Brisbane and Womens Hospital
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Ethics committee address [1]
258404
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Butterfield St, Herston Queensland 4029
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Ethics committee country [1]
258404
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Australia
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Date submitted for ethics approval [1]
258404
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11/08/2008
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Approval date [1]
258404
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24/09/2008
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Ethics approval number [1]
258404
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2008/101
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Summary
Brief summary
The current process for diagnosing heart attack (acute myocardial infarction; AMI) is to take multiple blood tests to measure cardiac troponin. The current definition for AMI requires troponin levels to be elevated (greater than the 99th percentile of a reference population) and to display a rising or falling pattern. However, this definition remains controversial as there is no clearly defined, evidence based data for how much the troponin level should change. We aim to identify what change in troponin value (percentage increase in troponin) has the greatest diagnostic accuracy for diagnosis of AMI. We will focus on the change in combination with the 99th percentile decision limit, at 0-2 hours and 0-6 hours after presentation using the Beckman Coulter Access AccuTnI assay.
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Trial website
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Trial related presentations / publications
Cullen L, Parsonage WA, Greenslade J, Lamanna A, Hammett CJ, Than M, Tate J, Kalinowski L, Ungerer JP, Chu K, Brown A. Delta troponin for the early diagnosis of AMI in emergency patients with chest pain. International Journal of Cardiology. 2013;168:2602-2608.
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Public notes
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Contacts
Principal investigator
Name
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A/Prof Louise Cullen
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Address
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Royal Brisbane and Women's Hospital
Butterfield Street
HERSTON QLD 4006
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Country
30710
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Australia
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Phone
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+61 7 3646 7901
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Fax
30710
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Email
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[email protected]
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Contact person for public queries
Name
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Louise Cullen
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Address
13957
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Dept of Emergency Medicine
RBWH
Butterfiled St
Herston Queensland 4029
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Country
13957
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Australia
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Phone
13957
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+61 7 3636 7901
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Fax
13957
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Email
13957
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[email protected]
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Contact person for scientific queries
Name
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Louise Cullen
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Address
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Dept of Emergency Medicine
RBWH
Butterfield St
Herston Queensland 4029
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Country
4885
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Australia
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Phone
4885
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+61 7 3636 7901
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Fax
4885
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Email
4885
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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