Why the study?
It was unknown whether the High-STEACS hs-cTnT pathway could achieve a ≥99% negative predictive value safety threshold for 30-day cardiac death or MI in US emergency department patients with and without known CAD.
Does the High-STEACS hs-cTnT pathway achieve a ≥99% negative predictive value for 30-day cardiac death or myocardial infarction in adult ED patients with possible ACS?
Does the High-STEACS hs-cTnT pathway achieve a ≥99% negative predictive value for 30-day cardiac death or myocardial infarction in adult ED patients with possible ACS?
The High-STEACS hs-cTnT pathway had high efficacy but failed to achieve the ≥99% negative predictive value safety threshold for 30-day cardiac death or MI in a US cohort of ED patients with possible ACS.
Answers are grounded in this paper and cite their sources.
Does not meet the ≥99% NPV safety threshold in this US cohort; leaves open whether the High-STEACS pathway requires modification before adoption.
BACKGROUND: The High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) pathway risk stratifies emergency department patients with possible acute coronary syndrome. This study aims to determine if the High-STEACS hs-cTnT (high-sensitivity cardiac troponin T) pathway can achieve the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (CDMI) in a multisite US cohort of patients with and without known coronary artery disease (CAD). METHODS: A secondary analysis of the STOP-CP (High-Sensitivity Cardiac Troponin T [Gen 5 STAT Assay] to Optimize Chest Pain Risk Stratification) cohort, which enrolled adult emergency department patients with possible acute coronary syndrome at 8 US sites (January 25, 2017-September 6, 2018). Participants were classified into outpatient and admission dispositions using the High-STEACS hs-cTnT pathway. Known CAD was defined as prior MI, coronary revascularization, or ≥70% coronary stenosis. Outcomes included 30-day CDMI and efficacy, defined as the proportion identified for outpatient disposition. NPVs and negative likelihood ratios for 30-day CDMI were calculated. NPVs were compared between CAD subgroups using a Fisher exact test. The negative likelihood ratio for 30-day CDMI among patients with CAD was 0.16 (95% CI, 0.08-0.31) and 0.12 (95% CI, 0.06-0.22) among patients without CAD. CONCLUSIONS: The High-STEACS hs-cTnT pathway had high efficacy but was unable to achieve the ≥99% NPV safety threshold for 30-day CDMI. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02984436.
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Ashburn et al. (2025) studied this question.
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