McCord JK, Cook B, Gandolfo C, Parikh S, Klausner H, Abdul-Nour K, Lewandowski A, Hudson MP, Perrotta GS, Zweig B, Gunaga S, Lanfear DE, Gindi R, Levy PD, Mills NL, Mahler S, Kim HE, Danagoulian S, Tang A, Nassereddine H, Oudeif A, Malette K, Krupp S, Keerie C, and Miller J. RACE-IT- RAPID MYOCARDIAL INFARCTION EXCLUSION USING AN ACCELERATED HIGH-SENSITIVITY CARDIAC TROPONIN I PROTOCOL: A PROSPECTIVE TRIAL. J Am Coll Cardiol 2022; 79(9):951.
J Am Coll Cardiol
Background: We compared the safety of our standard protocol to a new 0/1-hour high-sensitivity cardiac troponin I (hs-cTnI) protocol for exclusion of myocardial infarction (MI).
Methods: A stepped-wedge randomized trial of patients evaluated for possible MI in 9 Emergency Departments (ED) (urban and suburban) in the Henry Ford Health System (Detroit, MI) were studied from 7/2020-3/2021. Trial arms included the new 0/1-hour protocol and standard care. A hs-cTnI assay from Beckman Coulter was used (99th percentile 18 ng/L). Patients were excluded if any hs-cTnI was >18 ng/L within 3 hours or they were admitted to the hospital. In the 0/1-hour algorithm, MI was excluded if hs-cTnI <4 ng/L at time 0, or = 4 ng/L at time 0 with 1 hour <8 ng/L. The algorithm advised ED discharge if patients ruled-out by the 0/1-hour protocol. Otherwise, the protocol included another hs-cTnI at 3 hours. In the standard care arm, hs-cTnI was measured at 0 and 3 hours with values ≤18 ng/L used to exclude AMI and guide ED discharge decisions. The primary outcome was adjudicated death or MI at 30 days. The analysis included a mixed effect model adjusting for ED site, time, sex, age, and race.
Results: There were 22,345 patients in the trial. At 30 days there were 24 deaths and 26 MIs. There was no significant difference between the death/MI rate between the standard of care group and the accelerated protocol (Table).
Conclusion: Implementation of the 0/1-hour algorithm to evaluate for MI in the ED was safe when compared to standard care.