540 Performance of the high-sensitivity troponin in the evaluation of patients with acute coronary syndrome pathway among patients with known coronary disease in a United States population
Recommended Citation
Millard MJ, Ashburn NP, Snavely AC, Allen BR, Christenson RH, Madsen T, McCord J, Mumma BE, Hashemian T, Supples MW, Stopyra JP, Wilkerson R, Mahler SA. 540 Performance of the high-sensitivity troponin in the evaluation of patients with acute coronary syndrome pathway among patients with known coronary disease in a United States population. Acad Emerg Med 2024; 31(S1):254-255.
Document Type
Conference Proceeding
Publication Date
4-27-2024
Publication Title
Acad Emerg Med
Abstract
Background and Objectives: The high-sensitivity cardiac troponin T (hs-cTnT) High-STEACS early rule-out pathway is designed to rule-out myocardial infarction (MI) in emergency department (ED) patients with symptoms concerning for acute coronary syndrome (ACS). However, its diagnostic performance in patients with known coronary artery disease (CAD) is unclear. The objective of this study is to assess the performance of the algorithm among patients with and without known CAD in a multisite U.S. cohort. Methods: We conducted a secondary analysis of the STOP-CP cohort, which enrolled adult ED patients with possible ACS across 8 U.S. sites (1/25/2017–9/6/2018). Participants were stratified into outpatient and admission dispositions using established High-STEACS hs-cTnT (Roche, Basel, Switzerland) cut-points. Known CAD was determined by the treating provider and defined as prior MI, coronary revascularization, or ?70% coronary stenosis. Algorithm performance was evaluated for the adjudicated outcome of 30-day cardiac death or MI. Fisher's exact tests compared disposition and 30-day cardiac death or MI rates among patients with and without known CAD. Negative predictive values (NPV) for 30-day cardiac death or MI were calculated along with exact 95% confidence intervals and compared based on CAD status with a Fisher's exact test. Results: Among 1328 patients, 46.4% (616/1328) were female and 31.7% (421/1328) had known CAD, with a mean age of 57.4±12.8?years. At 30?days, cardiac death or MI occurred in 13.6% (180/1328). High-STEACS classified fewer patients with known CAD to the outpatient disposition vs. those without known CAD (47.0% [198/421] vs. 71.4% [648/907]; p?
Volume
31
Issue
S1
First Page
254
Last Page
255
