Rob Meek, Louise Cullen, Zhong Xian Lu, Arthur Nasis, Lisa Kuhn, Laurence Sorace
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Arrival, then 90-minute or 360-minute cTnI levels for low and non-low risk patients, respectively (ED Assessment of Chest pain score) guided diagnosis and disposition which was at treating physician discretion. The same patients had arrival and 90-minute or 180-minute samples drawn for hs-cTnI levels (Access hsTnI: LoD 2 ng/L, 99th centile URL 10 ng/L (females) and 20 ng/L (males); abnormal elevation above the URL and delta >30%). Treating physicians were blinded to the hs-cTnI results. Using the hs-cTnI values, investigators retrospectively assigned likely diagnosis, disposition and likelihood of a 30-day major adverse cardiac event (MACE). Admission was recommended for significantly rising hs-cTnI elevations. The primary objective was to demonstrate an acceptable unexpected 30-day post-discharge MACE rate of <1%. cTnI elevation rates, diagnostic outcomes and ED disposition were also compared between pathways.</p><p><strong>Results: </strong>For the 935 patients, unexpected 30-day post-discharge MACE rates were 0/935 (0%, 95% CI 0% to 0.4%) with the conventional or novel pathway. For the high-sensitivity and conventional assays, respectively, abnormal elevation rates were 29% (95% CI 26% to 32%) and 19% (95% CI 17% to 22%), for MI were 9% (95% CI 8% to 11%) and 8% (95% CI 6% to 10%), and for hospital admission were 42% (95% CI 39% to 45%) and 43% (95% CI 40% to 47%).</p><p><strong>Conclusion: </strong>The novel pathway using the Access hsTnI assay has an acceptably low 30-day MACE rate.</p>","PeriodicalId":410922,"journal":{"name":"Emergency medicine journal : EMJ","volume":" ","pages":"847-852"},"PeriodicalIF":0.0000,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Potential impact of a novel pathway for suspected myocardial infarction utilising a new high-sensitivity cardiac troponin I assay.\",\"authors\":\"Rob Meek, Louise Cullen, Zhong Xian Lu, Arthur Nasis, Lisa Kuhn, Laurence Sorace\",\"doi\":\"10.1136/emermed-2020-210812\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>High-sensitivity cardiac troponin I (hs-cTnI) assays promise high diagnostic accuracy for myocardial infarction (MI). In an ED where conventional cTnI was in use, we evaluated an assessment pathway using the new Access hsTnI assay.</p><p><strong>Methods: </strong>This retrospective analysis recruited ED patients with suspected MI between June and September 2019. All patients received routine care with a conventional cTnI assay (AccuTnI +3: limit of detection (LoD) 10 ng/L, 99th centile upper reference limit (URL) 40 ng/L, abnormal elevation cut-point 80 ng/L). Arrival, then 90-minute or 360-minute cTnI levels for low and non-low risk patients, respectively (ED Assessment of Chest pain score) guided diagnosis and disposition which was at treating physician discretion. The same patients had arrival and 90-minute or 180-minute samples drawn for hs-cTnI levels (Access hsTnI: LoD 2 ng/L, 99th centile URL 10 ng/L (females) and 20 ng/L (males); abnormal elevation above the URL and delta >30%). Treating physicians were blinded to the hs-cTnI results. Using the hs-cTnI values, investigators retrospectively assigned likely diagnosis, disposition and likelihood of a 30-day major adverse cardiac event (MACE). Admission was recommended for significantly rising hs-cTnI elevations. The primary objective was to demonstrate an acceptable unexpected 30-day post-discharge MACE rate of <1%. cTnI elevation rates, diagnostic outcomes and ED disposition were also compared between pathways.</p><p><strong>Results: </strong>For the 935 patients, unexpected 30-day post-discharge MACE rates were 0/935 (0%, 95% CI 0% to 0.4%) with the conventional or novel pathway. 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引用次数: 2
摘要
背景:高灵敏度心肌肌钙蛋白I (hs-cTnI)检测有望提高心肌梗死(MI)的诊断准确性。在使用传统cTnI的ED中，我们使用新的Access hsTnI检测方法评估了评估途径。方法:回顾性分析招募2019年6月至9月期间疑似心肌梗死的ED患者。所有患者均接受常规cTnI检测(AccuTnI +3:检测限(LoD) 10 ng/L, 99百分位参考上限(URL) 40 ng/L，异常升高临界点80 ng/L)。低危和非低危患者到达后，分别用90分钟或360分钟的cTnI水平(ED胸痛评分评估)指导诊断和处置，由治疗医生判断。同一患者到达医院后，在90分钟或180分钟内抽取样本检测hs-cTnI水平(Access hsTnI: LoD 2 ng/L，第99百分位URL 10 ng/L(女性)和20 ng/L(男性);异常标高高于URL和delta >30%)。治疗医生对hs-cTnI结果不知情。使用hs-cTnI值，研究人员回顾性地分配可能的诊断、处置和30天主要不良心脏事件(MACE)的可能性。hs-cTnI升高明显，建议入院治疗。主要目的是证明可接受的出院后30天意外MACE率:结果:对于935例患者，常规或新型途径的意外30天出院后MACE率为0/935 (0%，95% CI 0%至0.4%)。对于高灵敏度和常规检测，异常升高率分别为29% (95% CI 26%至32%)和19% (95% CI 17%至22%)，心肌梗死为9% (95% CI 8%至11%)和8% (95% CI 6%至10%)，住院为42% (95% CI 39%至45%)和43% (95% CI 40%至47%)。结论:使用Access hsTnI检测的新途径具有可接受的低30天MACE率。
Potential impact of a novel pathway for suspected myocardial infarction utilising a new high-sensitivity cardiac troponin I assay.
Background: High-sensitivity cardiac troponin I (hs-cTnI) assays promise high diagnostic accuracy for myocardial infarction (MI). In an ED where conventional cTnI was in use, we evaluated an assessment pathway using the new Access hsTnI assay.
Methods: This retrospective analysis recruited ED patients with suspected MI between June and September 2019. All patients received routine care with a conventional cTnI assay (AccuTnI +3: limit of detection (LoD) 10 ng/L, 99th centile upper reference limit (URL) 40 ng/L, abnormal elevation cut-point 80 ng/L). Arrival, then 90-minute or 360-minute cTnI levels for low and non-low risk patients, respectively (ED Assessment of Chest pain score) guided diagnosis and disposition which was at treating physician discretion. The same patients had arrival and 90-minute or 180-minute samples drawn for hs-cTnI levels (Access hsTnI: LoD 2 ng/L, 99th centile URL 10 ng/L (females) and 20 ng/L (males); abnormal elevation above the URL and delta >30%). Treating physicians were blinded to the hs-cTnI results. Using the hs-cTnI values, investigators retrospectively assigned likely diagnosis, disposition and likelihood of a 30-day major adverse cardiac event (MACE). Admission was recommended for significantly rising hs-cTnI elevations. The primary objective was to demonstrate an acceptable unexpected 30-day post-discharge MACE rate of <1%. cTnI elevation rates, diagnostic outcomes and ED disposition were also compared between pathways.
Results: For the 935 patients, unexpected 30-day post-discharge MACE rates were 0/935 (0%, 95% CI 0% to 0.4%) with the conventional or novel pathway. For the high-sensitivity and conventional assays, respectively, abnormal elevation rates were 29% (95% CI 26% to 32%) and 19% (95% CI 17% to 22%), for MI were 9% (95% CI 8% to 11%) and 8% (95% CI 6% to 10%), and for hospital admission were 42% (95% CI 39% to 45%) and 43% (95% CI 40% to 47%).
Conclusion: The novel pathway using the Access hsTnI assay has an acceptably low 30-day MACE rate.
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