The LOD HSTnT strategy and HEART score ≤3 ruled out 6-week MACE with >99% certainty (NPV 99.8% and 99.4%), allowing early discharge of 36.9% and 53.4% of suspected ACS patients, respectively.
Cohort (n=1,642)
Yes
Do decision rules like HEART score ≤3 or LOD HSTnT strategy safely rule out MACE to allow early discharge in patients with suspected acute coronary syndrome?
Both the HEART score ≤3 and a single high-sensitivity troponin at the limit of detection with a non-ischaemic ECG safely rule out short-term MACE with >99% certainty in suspected ACS, facilitating early discharge.
BACKGROUND: We tested the hypothesis that a single high sensitivity troponin at limits of detection (LOD HSTnT) (99% for MACE at six weeks. For type 1 myocardial infarction alone the negative predictive values at six weeks and one year were identical, for both HEART ≤3 and LOD HSTnT at 99.8% and 99.5% respectively. CONCLUSION: HEART ≤3 or LOD HSTnT strategy rules out short and medium term myocardial infarction with ≥99.5% certainty, and short-term MACE with >99% certainty, allowing for early discharge of 53.4% and 36.9% respectively of suspected acute coronary syndrome. Adoption of either strategy has the potential to greatly reduce Emergency Room pressures and minimise follow-up investigations. Very early presenters (<3 h), due to limited numbers, are excluded from these conclusions.
Chew et al. (2018) conducted a cohort in suspected acute coronary syndrome (n=1,642). LOD HSTnT strategy vs. GRACE, TIMI, and HEART scores was evaluated on Composite of type 1 myocardial infarction, unplanned coronary revascularisation and all cause death (MACE) at six weeks and one year. The LOD HSTnT strategy and HEART score ≤3 ruled out 6-week MACE with >99% certainty (NPV 99.8% and 99.4%), allowing early discharge of 36.9% and 53.4% of suspected ACS patients, respectively.