ESC 2019 — High-STEACS hs-cTnI threshold has a HiSTORIC moment


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • High-STEACS trial results setting risk-stratification thresholds for high-sensitivity cardiac troponin I (hs-cTnI) in suspected acute coronary syndrome (ACS) have been implemented in HiSTORIC, and researchers report application of these thresholds is “effective and safe.”
  • HiSTORIC trial findings also suggest reduced emergency department (ED) length of stay (LOS) with application of this early rule-out pathway. 

Why this matters

  • High-STEACS assessed risk stratification thresholds in ACS.
  • HiSTORIC: evaluated validity of these thresholds in terms of ED LOS as the primary endpoint and a secondary endpoint of ED discharge rates.
  • HiSTORIC authors conclude that the High-STEACS early rule-out using th centile and serial 6-12-hour testing.

Results

  • Using 5 ng/L as rule-out for myocardial infarction was tied to negative predictive value of 99.5%.
  • LOS with early rule-out was decreased by 3.3 hours: 10.1 hours with 99th centile vs 6.8 hours with early rule-out.
  • ED discharge rates also increased with early rule-out: 75% vs 53% (P<.0001>
  • No significant differences in cardiac, all-cause death at 30 days or 1 year, although early rule-out yielded numerically lower rates: 
    • 30 days: 0.3% vs 0.4%.
    • 1 year: 1.8% vs 2.7%.

Study design

  • HiSTORIC: stepped-wedge, cluster-randomized trial; 16,792 with early rule-out applied vs 14,700 with standard rule-outs.
  • Funding: British Heart Foundation; Abbott Laboratories provided assay materials. 

Limitations

  • HiSTORIC results presented at a conference without peer review.