R Gentry Wilkerson, Nicklaus P Ashburn, Anna C Snavely, Brandon R Allen, Robert H Christenson, Michael Weaver, Xiaoxi Zhang, Troy E Madsen, Bryn E Mumma, Michael W Supples, Simon A Mahler
{"title":"高灵敏度肌钙蛋白T风险分层策略对90天内心脏性死亡或心肌梗死的影响","authors":"R Gentry Wilkerson, Nicklaus P Ashburn, Anna C Snavely, Brandon R Allen, Robert H Christenson, Michael Weaver, Xiaoxi Zhang, Troy E Madsen, Bryn E Mumma, Michael W Supples, Simon A Mahler","doi":"10.1097/HPC.0000000000000397","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Thirty-day performance of the high-sensitivity troponin T (hs-cTnT) European Society of Cardiology 0/1-hour (ESC 0/1-h) and \"one-and-done\" (hs-cTnT<limit of quantification [LoQ]) strategies are established. However, 90-day performance is unclear. Our objective was to evaluate the 90-day performance of these hs-cTnT strategies in a U.S. cohort.</p><p><strong>Methods: </strong>A pre-planned secondary analysis of a prospective multisite U.S. cohort was conducted. Adults with chest pain were enrolled from eight emergency departments (1/2017-9/2018). hs-cTnT measures (0- and 1-h) were used to classify patients by the ESC 0/1-h algorithm into rule-out, observation, and rule-in zones. Patients with 0-h measures <LoQ were considered ruled-out by the one-and-done strategy. The primary outcome was adjudicated 90-day cardiac death or MI. Negative predictive value (NPV) for the primary endpoint and efficacy (proportion ruled-out) were calculated for each strategy alone and in combination with the HEART score.</p><p><strong>Results: </strong>Among 1462 patients with a mean age of 57.6±12.9 years, 46.4% (678/1462) were female and 14.0% (205/1462) had cardiac death or MI at 90 days. One-and-done strategy efficacy was 32.8% (479/1462) and NPV was 99.0% (95%CI, 97.6-99.7). Adding the HEART score decreased efficacy to 20.1% (293/1462) and increased NPV to 99.7% (95%CI, 98.1-100). ESC 0/1-h efficacy was 57.8% (826/1430) and NPV was 98.3% (95%CI, 97.2-99.1). Combined with a HEART score NPV increased to 99.3% (95%CI, 98.0-99.9) but efficacy decreased to 30.8% (95%CI, 28.3-33.2).</p><p><strong>Conclusion: </strong>The one-and-done strategy and ESC 0/1-hour algorithm had modest rates of missed 90-day cardiac death or MI. Adding a HEART score improved safety but decreased efficacy.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Performance of High-Sensitivity Troponin T Risk Stratification Strategies for 90-day Cardiac Death or Myocardial Infarction.\",\"authors\":\"R Gentry Wilkerson, Nicklaus P Ashburn, Anna C Snavely, Brandon R Allen, Robert H Christenson, Michael Weaver, Xiaoxi Zhang, Troy E Madsen, Bryn E Mumma, Michael W Supples, Simon A Mahler\",\"doi\":\"10.1097/HPC.0000000000000397\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Thirty-day performance of the high-sensitivity troponin T (hs-cTnT) European Society of Cardiology 0/1-hour (ESC 0/1-h) and \\\"one-and-done\\\" (hs-cTnT<limit of quantification [LoQ]) strategies are established. However, 90-day performance is unclear. Our objective was to evaluate the 90-day performance of these hs-cTnT strategies in a U.S. cohort.</p><p><strong>Methods: </strong>A pre-planned secondary analysis of a prospective multisite U.S. cohort was conducted. Adults with chest pain were enrolled from eight emergency departments (1/2017-9/2018). hs-cTnT measures (0- and 1-h) were used to classify patients by the ESC 0/1-h algorithm into rule-out, observation, and rule-in zones. Patients with 0-h measures <LoQ were considered ruled-out by the one-and-done strategy. The primary outcome was adjudicated 90-day cardiac death or MI. Negative predictive value (NPV) for the primary endpoint and efficacy (proportion ruled-out) were calculated for each strategy alone and in combination with the HEART score.</p><p><strong>Results: </strong>Among 1462 patients with a mean age of 57.6±12.9 years, 46.4% (678/1462) were female and 14.0% (205/1462) had cardiac death or MI at 90 days. One-and-done strategy efficacy was 32.8% (479/1462) and NPV was 99.0% (95%CI, 97.6-99.7). Adding the HEART score decreased efficacy to 20.1% (293/1462) and increased NPV to 99.7% (95%CI, 98.1-100). ESC 0/1-h efficacy was 57.8% (826/1430) and NPV was 98.3% (95%CI, 97.2-99.1). Combined with a HEART score NPV increased to 99.3% (95%CI, 98.0-99.9) but efficacy decreased to 30.8% (95%CI, 28.3-33.2).</p><p><strong>Conclusion: </strong>The one-and-done strategy and ESC 0/1-hour algorithm had modest rates of missed 90-day cardiac death or MI. Adding a HEART score improved safety but decreased efficacy.</p>\",\"PeriodicalId\":35914,\"journal\":{\"name\":\"Critical Pathways in Cardiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Pathways in Cardiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/HPC.0000000000000397\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Pathways in Cardiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/HPC.0000000000000397","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Performance of High-Sensitivity Troponin T Risk Stratification Strategies for 90-day Cardiac Death or Myocardial Infarction.
Background: Thirty-day performance of the high-sensitivity troponin T (hs-cTnT) European Society of Cardiology 0/1-hour (ESC 0/1-h) and "one-and-done" (hs-cTnT
Methods: A pre-planned secondary analysis of a prospective multisite U.S. cohort was conducted. Adults with chest pain were enrolled from eight emergency departments (1/2017-9/2018). hs-cTnT measures (0- and 1-h) were used to classify patients by the ESC 0/1-h algorithm into rule-out, observation, and rule-in zones. Patients with 0-h measures
Results: Among 1462 patients with a mean age of 57.6±12.9 years, 46.4% (678/1462) were female and 14.0% (205/1462) had cardiac death or MI at 90 days. One-and-done strategy efficacy was 32.8% (479/1462) and NPV was 99.0% (95%CI, 97.6-99.7). Adding the HEART score decreased efficacy to 20.1% (293/1462) and increased NPV to 99.7% (95%CI, 98.1-100). ESC 0/1-h efficacy was 57.8% (826/1430) and NPV was 98.3% (95%CI, 97.2-99.1). Combined with a HEART score NPV increased to 99.3% (95%CI, 98.0-99.9) but efficacy decreased to 30.8% (95%CI, 28.3-33.2).
Conclusion: The one-and-done strategy and ESC 0/1-hour algorithm had modest rates of missed 90-day cardiac death or MI. Adding a HEART score improved safety but decreased efficacy.
期刊介绍：
Critical Pathways in Cardiology provides a single source for the diagnostic and therapeutic protocols in use at hospitals worldwide for patients with cardiac disorders. The Journal presents critical pathways for specific diagnoses—complete with evidence-based rationales—and also publishes studies of these protocols" effectiveness.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
