- 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.
- 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%.
- 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.
- HiSTORIC results presented at a conference without peer review.