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Multicenter Study
Accelerated diagnostic protocol using high-sensitivity cardiac troponin T in acute chest pain patients.
- Bernadette Meller, Louise Cullen, William A Parsonage, Jaimi H Greenslade, Sally Aldous, Tobias Reichlin, Karin Wildi, Raphael Twerenbold, Cedric Jaeger, Petra Hillinger, Philip Haaf, Christian Puelacher, ... more
- Department of Cardiology, University Hospital, Basel, Switzerland.
- Int. J. Cardiol. 2015 Apr 1;184:208-15.
BackgroundWe aimed to evaluate the efficacy and safety of using high-sensitivity cardiac troponin T (hs-cTnT) within an accelerated diagnostic protocol (ADP) in patients presenting with symptoms suggestive of acute myocardial infarction (AMI) for rapid rule-out of AMI.MethodsIn two independent large multicenter studies, levels of hs-cTnT at presentation and at 2 h were combined with the Thrombolysis In Myocardial Infarction (TIMI) risk score and ECG findings. The ADP defined patients with normal levels of hs-cTnT at presentation and 2 h, a TIMI score ≤1, and normal ECG findings as candidates for rapid rule-out of AMI and rapid discharge. Major adverse cardiac events (MACEs) occurring within 30-days were centrally adjudicated by two independent cardiologists.ResultsIn the derivation cohort, among 1085 consecutive patients 198 patients (18.2%) had a MACE. The ADP classified 374 patients (34.5%) as low-risk. None of these patients had a MACE at 30 days, resulting in a negative predictive value (NPV) of 100% (95% CI, 99.0-100%) and a sensitivity of 100% (95% CI, 98.2%-100%). In the validation cohort, among 1590 consecutive patients 231 patients (14.5%) had a MACE. The ADP classified 641 patients (40.3%) as low-risk. 6 of these patients had a MACE at 30 days, resulting in a NPV of 99.1% (95% CI, 98.0-99.6%) and a sensitivity of 97.4% (95% CI, 94.5-98.8%).ConclusionsThe ADP including hs-cTnT allows early identification 35 to 40% of patients to be at extremely low risk of MACE and therefore ideal candidates for outpatient management.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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