• Am J Emerg Med · Aug 2020

    Performance of cardiac troponins within the HEART score in predicting major adverse cardiac events at the emergency department.

    • Jack Wei Chieh Tan, Hong Jie Gabriel Tan, Anders Olof Sahlen, Khung Keong Yeo, Woon Loong Calvin Chin, Fei Gao, Ong Eng Hock Marcus EHM Department of Emergency Medicine, Singapore General Hospital, Singapore. Electronic address: marcus.ong.e.h@singhealth.com.sg., Chin Pin Yeo, Wai Yoong Ng, and Swee Han Lim.
    • Department of Cardiology, National Heart Centre Singapore, Singapore. Electronic address: jack.tan.w.c@singhealth.com.sg.
    • Am J Emerg Med. 2020 Aug 1; 38 (8): 1560-1567.

    BackgroundThis study compared the performance of a single blood draw of high-sensitivity troponin T (hsTnT), high-sensitivity troponin I (hsTnI) and conventional troponin I (cTnI) within a modified HEART score for predicting 30-day MACE at Emergency Department (ED) presentation, and established local reference norms for all three assays by determining the cut-off point which yielded the highest sensitivity and negative predictive value for acute myocardial infarction and 30-day MACE.MethodsThis single-center prospective cohort study recruited chest pain patients at the ED, whose hsTnT, hsTnI and cTnI were taken on admission. Subjects were classified into low and non-low risk group according to their modified HEART score, with MACE as the primary endpoint. Receiver-operating characteristic (ROC) curves were generated, area under the curves (AUCs) were calculated; the performance characteristics were determined.ResultsThe performance of modified HEART scores was comparable among the three assays for 30-day MACE (84.9-87.0% sensitivity, 95.6-96.0% NPV, 95%CI) and none of these had very high AUC and specificity (AUC 0.70-0.71, 53.7-56.7% specificity, 95% CI). The modified HEART score using a single blood draw of either hsTnT (3.9ng/L), hsTnI (0.9ng/L) or cTnI (0.0ng/L) at presentation yielded a sensitivity of 100% for 30-day MACE.ConclusionThe modified HEART score using a single blood draw of either hsTnT, hsTnI or cTnI was equally effective in risk-stratifying chest pain patients for safe discharge. The theoretical cut-off points yielding 100% sensitivity are potentially useful (when achieved) for safely discharging low risk patients with undifferentiated chest pain in the ED.Copyright © 2019 Elsevier Inc. All rights reserved.

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