Dr. Allen is the medical director of the Shands Emergency Room at UF Health. The emergency department scribe program, observation medicine, emergency department quality and throughput innovation, and cardiac biomarkers research are some of his main interests. In this video Dr. Allen talks about his research with the Diagnostic Performance of High-Sensitivity Cardiac Troponin T Strategies and Clinical Variables in a Multisite US Cohort.
Link to Abstract-
Low high-sensitivity troponin (hs-cTn) readings or a 0/1-hour (0/1-h) strategy for myocardial infarction are recommended in Europe to rule out major adverse cardiac events (MACEs) in patients with suspected acute coronary syndrome. However, there is just limited data from the United States to back up these techniques. In a multisite US population, researchers looked at the diagnostic performance of an initial hs-cTnT value below the limit of quantification (LOQ: 6 ng/L), a 0/1-h methodology, and their combination with history, ECG, age, risk factors, and initial troponin (HEART) scores for eliminating MACE.
Adult patients in the emergency department with symptoms suggestive of acute coronary syndrome but no ST-elevation on ECG were enrolled in a prospective cohort study at eight US sites. hs-cTnT (Roche; Basel, Switzerland) was evaluated using baseline and 1-hour blood samples. HEART scores were determined prospectively by treating clinicians who were blinded to the hs-cTnT data. At 30 days, MACE (cardiac death, myocardial infarction, and coronary revascularization) was determined. A 0/1-h approach was used to determine the proportion of individuals with first hs-cTnT measurements below the LOQ and risk. When both techniques were applied alone and with a HEART score, the negative predictive value (NPV) was obtained.
46.4 percent (678 of 1462) of the 1462 participants with initial hs-cTnT measurements were women, and 37.1 percent (542 of 1462) were Black, with a mean age of 57.612.9 (SD) years. MACEs occurred in 14.4% (210 of 1462) of participants after 30 days. Initial hs-cTnT measurements below the LOQ were found in 32.8 percent (479 of 1462), resulting in a 30-day MACE NPV of 98.3 percent (95 percent CI, 96.7–99.3). A low-risk HEART score with an initial hs-cTnT below the LOQ was found in 20.1 percent (294 of 1462), resulting in a 30-day MACE NPV of 99.0 percent (95 percent CI, 97.0–99.8). In 1430 patients, a 0/1-h algorithm was completed, ruling out 57.8% (826 of 1430) of 30-day MACEs with an NPV of 97.2 percent (95 percent CI, 95.9–98.2). When a low HEART score was included to the 0/1-h methodology, 30.8 percent (441 of 1430) of 30-day MACEs were ruled out, with an NPV of 98.4 percent (95 percent CI, 96.8–99.4).
An initial hs-cTnT below the LOQ combined with a low-risk HEART score provides a 99 percent NPV for 30-day MACEs in a prospective multisite US population. When employed alone or with a HEART score, the 0/1-h hs-cTnT algorithm did not produce an NPV >99 percent for 30-day MACEs.