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