Key result
Short 0-1h hs-cTnI protocol shows no diagnostic accuracy benefit over standard 0-3h testing for AMI.
Why the study?
Recent guidelines recommend a short 0-1h hs-cTn algorithm for chest pain patients at the ED, but its safety and effectiveness compared to the standard 0-3h protocol needed evaluation.
Does the short 0-1h hs-cTn I protocol improve the accuracy of AMI diagnosis and reduce length of stay in patients presenting with chest pain at the ED compared to the standard 0-3h cTn I protocol?
Observational (n=200)
Does the short 0-1h hs-cTn I protocol improve the accuracy of AMI diagnosis and reduce length of stay in patients presenting with chest pain at the ED compared to the standard 0-3h cTn I protocol?
Absolute Event Rate: 94% vs 88%
p-value: p=0.14
The abbreviated 0-1h hs-cTn I protocol is effective and safe for excluding AMI in the emergency department, with a trend towards higher early discharge rates and shorter length of stay.
Supports 0-1h hs-cTn I safety in this ED cohort; leaves open prospective validation before practice change.
Aim Recent guidelines recommend the use of a short 0-1h high sensitive cardiac troponin (hs-cTn) algorithm in patients presenting with chest pain at the emergency department (ED). This retrospective observational study evaluates the safety and effectiveness of the new 0-1h hs-cTn I protocol in comparison with the standard 0-3h cTn I protocol for the diagnosis of acute myocardial infarction (AMI).Methods A total of two times 100 consecutive chest pain patients presenting at the ED in November/December 2018 (standard 0-3h cTn I group) and in November/December 2020 (short 0-1h hs-cTn I group) were enrolled. Decision making was based upon validated assay-specific cut-off values.Results The new 0-1h hs-cTn I protocol had a sensitivity of 100% (95% CI 83.2–100) and a negative predictive value of 100% to rule out AMI. The accuracy of rule-in was slightly lower with a specificity of 92.5% (95% CI 84.4–97.2). The overall protocol accuracy was 94% (95% CI 87.4–97.8) in the short 0-1h hs-cTn I group compared to 88% (95% CI 80.0–93.6) in the standard 0-3h cTn I group (p-value 0.14). The 0-1h hs-cTn I protocol was associated with a numerically higher rate of early hospital discharge compared to the conventional 0-3h cTn I protocol (47% versus 59%; p-value 0.09) and with a shorter median length of stay for those patients (mean 316 min versus 289 min; p-value 0.09).Conclusion The abbreviated protocol based on the 0-1h hs-cTn I assays is effective and safe for the exclusion of AMI at the ED.
No takes yet. Share an insight, caveat, or question.
Assche et al. (2023) conducted an observational in Chest pain / suspected acute myocardial infarction (n=200). Short 0-1h high sensitive cardiac troponin I protocol vs. Standard 0-3h cardiac troponin I protocol was evaluated on Overall protocol accuracy for the diagnosis of acute myocardial infarction (p=0.14). The short 0-1h high-sensitive troponin I protocol had an overall diagnostic accuracy of 94% compared to 88% for the standard 0-3h protocol in patients with chest pain (P=0.14).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: