Potential impact of a novel pathway for suspected myocardial infarction utilising a new high-sensitivity cardiac troponin I assay

Journal article


Meek, Robert, Cullen, Louise, Lu, Zhong Xian, Nasis, Arthur, Kuhn, Lisa and Sorace, Laurence. (2022). Potential impact of a novel pathway for suspected myocardial infarction utilising a new high-sensitivity cardiac troponin I assay. Emergency Medicine Journal. 39(11), pp. 847-852. https://doi.org/10.1136/emermed-2020-210812
AuthorsMeek, Robert, Cullen, Louise, Lu, Zhong Xian, Nasis, Arthur, Kuhn, Lisa and Sorace, Laurence
Abstract

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.

Year2022
JournalEmergency Medicine Journal
Journal citation39 (11), pp. 847-852
PublisherBMJ Publishing Group
ISSN1472-0213
Digital Object Identifier (DOI)https://doi.org/10.1136/emermed-2020-210812
PubMed ID34759013
Scopus EID2-s2.0-85140417610
Page range847-852
FunderBeckman Coulter, Inc.
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online10 Nov 2021
Publication process dates
Accepted27 Oct 2021
Deposited28 Nov 2023
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