Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardial infarction or death at presentation to the emergency department
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Key result
A clinical chemistry score of 0 points achieved 100% sensitivity for 30-day myocardial infarction or death, outperforming high-sensitivity cardiac troponin alone for identifying low-risk patients.
Why the study?
Does a clinical chemistry score incorporating hs-cTn, glucose, and eGFR improve risk stratification for 30-day myocardial infarction or death compared to hs-cTn alone in patients presenting to the emergency department with suspected acute coronary syndrome?
Population
4,245 patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome…
Comparison
Clinical chemistry score ranging from 0-5… vs High-sensitivity cardiac troponin tests alone.
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
May aid ED discharge decisions if validated; leaves open need for prospective outcome trials in suspected ACS.
Study Design
Type
Cohort (n=4,245)
Multicenter
Yes
Structured PICO
Does a clinical chemistry score incorporating hs-cTn, glucose, and eGFR improve risk stratification for 30-day myocardial infarction or death compared to hs-cTn alone in patients presenting to the emergency department with suspected acute coronary syndrome?
P
Population
4,245 patients presenting to the emergency department with symptoms suggestive of acute coronary syndrome, evaluated for 30-day myocardial infarction or death.
E
Exposure
Clinical chemistry score (CCS) ranging from 0-5 points, incorporating high-sensitivity cardiac troponin (hs-cTnI or hs-cTnT), glucose level, and estimated glomerular filtration rate (eGFR).
C
Comparator
High-sensitivity cardiac troponin (hs-cTnI or hs-cTnT) tests alone (e.g., hs-cTnI < 5 ng/L or hs-cTnT < 6 ng/L for low risk; overall 99th percentiles for high risk).
O
Outcome
Composite of 30-day myocardial infarction (MI) or all-cause death.composite
Main Result
Absolute Event Rate: 100% vs 96.6%
A simple clinical chemistry score combining hs-cTn, glucose, and eGFR safely and effectively identifies emergency department patients at low and high risk for 30-day MI or death, outperforming hs-cTn alone.
Limitations
- Only about 10% of patients would be considered to be at low risk using the score.
- Outcomes were only assessed to 30 days after presentation to the emergency department.
- Each site employed different cardiac troponin assays and change criteria for the adjudication of myocardial infarction.
- Post hoc analysis
Cite This Study
Kavsak et al. (2018) conducted a cohort in Suspected acute coronary syndrome (n=4,245). Clinical chemistry score (CCS) vs. High-sensitivity cardiac troponin alone was evaluated on Sensitivity for 30-day myocardial infarction or death (hs-cTnI CCS = 0 vs hs-cTnI < 5 ng/L) (95% CI 99.5-100). A clinical chemistry score of 0 points achieved 100% sensitivity for 30-day myocardial infarction or death, outperforming high-sensitivity cardiac troponin alone for identifying low-risk patients.
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