280 Exploring the value of nonspecific electrocardiogram findings in the setting of low high-sensitivity troponin levels
Recommended Citation
Husain A, Hawatian K, Emakhu JO, Morton TJ, Cook B, Klausner N, Schwab E, Nassereddine H, Tuttle JE, Wanis N, Almri Y, Klausner HA, Gunaga S, Krupp SS, McCord J, Miller J. 280 Exploring the value of nonspecific electrocardiogram findings in the setting of low high-sensitivity troponin levels. Acad Emerg Med 2024; 31(S1):136.
Document Type
Conference Proceeding
Publication Date
5-13-2024
Publication Title
Acad Emerg Med
Abstract
Background and Objectives: The value of non-specific electrocardiogram (ns-ECG) findings to modify the risk for myocardial infarction (MI) in the context of low high-sensitivity cardiac troponin I (hs-cTnI) is uncertain. Our objective was to assess the relationship between ns-ECG findings and the occurrence of 30-day major adverse cardiac events (MACE) among patients with low hs-cTnI values. Methods: We conducted a secondary analysis of the RACE-IT trial, a cluster randomized trial performed across 9 EDs from July 2020 through March 2021. The trial included all patients being evaluated for MI and tested the safety and effectiveness of a 0/1-h accelerated protocol using hs-cTnI compared to conventional troponin testing using a 0/3-h protocol. The trial excluded patients with ST-elevation MI and hs-cTnI values >?99th percentile. For this analysis, we included patients that ruled-out in 0/1-h (all hs-cTnI values <8?ng/L). We defined ns-ECG findings as left bundle branch block (LBBB), ST-segment depression or elevation less than 1?mm, or T-wave inversions (TWI). Adjudicators determined 30-day MACE (death or MI). Analysis included descriptive statistics and multivariable logistic regression. Results: We included 16,606 patients who ruled-out for MI within 1-h in this analysis. The mean age was 53.4?years (SD 17.8), 9820 (59.3%) were female, and 5367 (32.3%) Black. There were 3345 (20.1%) patients with ns-ECG findings, of which 2145 (12.9%) had ST-segment changes and 1317 (8.4%) had TWI. Thirty-day MACE occurred in 66 (0.40%) patients, including 47 (0.29%) deaths (38 adjudicated as non-cardiac) and 19 (0.11%) MIs (16 adjudicated as Type II AMI). There was no significant difference in MACE events based on the presence of ns-ECG findings overall (OR 1.38, 95% CI 0.79–2.39, p?=?0.257). The presence of ST-segment changes, however, had a trend towards greater odds of MACE (OR 2.53, 95% CI 0.92–6.99, p?=?0.076). Conclusion: Non-specific ECG findings in the setting of low hs-TnI were not associated with greater MACE events in this large trial with a low overall prevalence of MACE.
Volume
31
Issue
S1
First Page
136
