Performance of the High-Sensitivity Cardiac Troponin T 0/2-h Accelerated Diagnostic Protocol at 90 day
Recommended Citation
Supples M, Snavely AC, Ashburn NP, Allen BR, Christenson R, Nowak RM, Wilkerson R, Mumma BE, Madsen T, Stopyra JP, Mahler SA. Performance of the High-Sensitivity Cardiac Troponin T 0/2-h Accelerated Diagnostic Protocol at 90 day. Acad Emerg Med 2023; 30:241.
Document Type
Conference Proceeding
Publication Date
4-20-2023
Publication Title
Acad Emerg Med
Abstract
Background and Objectives: The high-sensitivity troponin T 0/2-h algorithm is a validated protocol for risk stratifying emergency department patients with suspected acute coronary syndrome (ACS). We recently evaluated its performance at 30-days in US patients, but limited data exist regarding its longer-term risk prediction. The objective of this study is to evaluate the safety and efficacy of the 0/2-h algorithm at 90 day in a multisite US cohort. Methods: We conducted a pre-planned secondary analysis of the STOP-CP cohort, a prospective observational study that enrolled adult ED patients (≥21 years old) with suspected ACS and without ST-elevation on initial ECG across 8 US sites (1/25/2017-9/ 6/2018). High-sensitivity troponin T (hs-cTnT; Roche, Basel, Switzerland) measures at 0-and 2-h were used to stratify patients into rule-out, observe, and rule-in groups, based on the 0/2-h algorithm. Cardiac death or myocardial infarction (MI) and major adverse cardiovascular events (MACE; the composite of cardiac death, MI, and coronary revascularization) at 90-days were adjudicated. Negative and positive predictive values (NPV and PPV) and negative and positive likelihood ratios (-LR and +LR) were calculated for each outcome with 95% confidence intervals. Results: Among 1307 patients, 46.4% (607/1307) were female, and 58.3% (762/1307) were white patients and they had a median age of 57.2 years (IQR 49.1-66.0). The 0/2-h algorithm ruled out 61.4% (802/1307) and ruled in 12.4% (162/1307). Among rule-out patients, 90-day cardiac death or MI occurred in 2.0% (16/802) and MACE in 3.7% (30/802). This yielded a NPV of 98.0% (95% CI 96.8-98.9%) and -LR of 0.13 (95% CI 0.08-0.20) for cardiac death or MI and a NPV of 96.3% (95% CI 94.7-97.5%) and -LR of 0.21 (95% CI 0.15-0.29) for MACE. Among rule-in patients, 90-day cardiac death or MI occurred in 63.6% (103/162) and 90-day MACE occurred in 64.2% (104/162). The PPV for 90-day cardiac death or MI was 63.6% (95% CI 55.7-71.0%) with a +LR was 10.9 (95% CI 8.2-14.4). For 90-day MACE the PPV was 64.2% (95% CI 56.3-71.6%) and +LR was 9.7 (95% CI 7.3-12.9). Conclusion: In this multisite US cohort, the 0/2-h algorithm ruled-out a majority of patients, but failed to achieve 99% or better NPV for 90-day MACE.
Volume
30
First Page
241
