Using hs-cTnI for risk assessment misses fewer events in suspected ACS

  • Chapman AR & al.
  • Heart
  • 15 Nov 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Rule-out pathways in suspected acute coronary syndrome (ACS) that use low high-sensitivity (hs)-cardiac troponin (cTn) I values miss fewer events than decisions based on 99th centile.
  • New Atellica IM high-sensitivity troponin I (Siemens Healthineers) was tested in this prospective observational study using High-Sensitivity Troponin in the Evaluation of patients with Acute Coronary Syndrome (High-STEACS), European Society of Cardiology (ESC) 1-hour pathway (ESC-1), and 99th centile diagnostic threshold in the ESC 3-hour pathway (ESC-3) for predictive value for myocardial infarction (MI).

Why this matters

  • This assay aided in 2 different rule-out pathways.
  • Patient-level meta-analysis showed high predictive value (99.5%) of hs-cTnI

Key results

  • 30-day MI/cardiac death in 14.4%.
  • High-STEACS (95% CIs): 
    • Rule-out: 63.4%.
    • 5 missed events.
    • Negative predictive value (NPV): 99.5% (99.1%-99.8%).
    • Sensitivity: 98.0% (96.4%-99.5%).
  • ESC 1-hour (95% CIs):
    • Rule-out: 64.5%.
    • 2 missed.
    • NPV: 99.0% (97.6%-99.8%).
    • Sensitivity: 92.2% (83%-99.4%).
  • ESC 3-hour (95% CIs):
    • Rule-out: 65%.
    • 25 missed events.
    • NPV: 98.0% (97.1%-98.7%).
    • Sensitivity: 90.8% (87.4%-94.1%).

Study design

  • n=1920 with suspected ACS, hs-cTnI values available; large emergency department in tertiary cardiology center.
  • Funding: British Heart Foundation; Siemens Healthcare Diagnostics. 

Limitations

  • Single-center, observational.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit