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
Authors | Meek, Robert, Cullen, Louise, Lu, Zhong Xian, Nasis, Arthur, Kuhn, Lisa and Sorace, Laurence |
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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. |
Year | 2022 |
Journal | Emergency Medicine Journal |
Journal citation | 39 (11), pp. 847-852 |
Publisher | BMJ Publishing Group |
ISSN | 1472-0213 |
Digital Object Identifier (DOI) | https://doi.org/10.1136/emermed-2020-210812 |
PubMed ID | 34759013 |
Scopus EID | 2-s2.0-85140417610 |
Page range | 847-852 |
Funder | Beckman Coulter, Inc. |
Publisher's version | License All rights reserved File Access Level Controlled |
Output status | Published |
Publication dates | |
Online | 10 Nov 2021 |
Publication process dates | |
Accepted | 27 Oct 2021 |
Deposited | 28 Nov 2023 |
https://acuresearchbank.acu.edu.au/item/90043/potential-impact-of-a-novel-pathway-for-suspected-myocardial-infarction-utilising-a-new-high-sensitivity-cardiac-troponin-i-assay
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