An assessment pathway using the Access hsTnI assay resulted in an unexpected 30-day post-discharge MACE rate of 0% (95% CI 0% to 0.4%), identical to the conventional cTnI pathway.
Cohort (n=935)
Single-blind
No
Does an assessment pathway using a new high-sensitivity cardiac troponin I assay maintain an acceptable unexpected 30-day post-discharge MACE rate compared to a conventional assay in ED patients with suspected MI?
A novel ED assessment pathway using the Access hsTnI assay demonstrated an acceptably low unexpected 30-day MACE rate of 0%, comparable to conventional cTnI testing.
Tasa de eventos absoluta: 0% vs 0%
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.
Meek et al. (Wed,) conducted a cohort in Suspected myocardial infarction (n=935). Access hsTnI assay pathway vs. Conventional cTnI assay (AccuTnI +3) pathway was evaluated on Unexpected 30-day post-discharge major adverse cardiac event (MACE) (95% CI 0 to 0.4). An assessment pathway using the Access hsTnI assay resulted in an unexpected 30-day post-discharge MACE rate of 0% (95% CI 0% to 0.4%), identical to the conventional cTnI pathway.