Vessel Plus 2022;6:[Accepted].10.20517/2574-1209.2022.34© The Author(s) 2023 Accepted Manuscript
Open AccessOriginal Article
Efficacy and safety of a 0/1-h high-sensitivity cardiac troponin I (hs-cTnI) protocol to rule out acute coronary syndrome over a one-year period
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Kelly Perryman, David Winchester, Michael Massoomi, Elizabeth Warren, Linda Morris, Stacy Beal, Nila Radhakrishnan, Umar Ghaffar, Jacob Sammon, Justin Raman, Marsha Lewis, David Crabb, Liam Holtzman, Brandon Allen
Correspondence Address: Dr. Brandon Allen, Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, PO Box 100186, Gainesville, FL 32610-0186, USA. E-mail: brandonrallen@ufl.edu
Received: 13 Jun 2022 | Revised: 10 Oct 2022 | Accepted: 21 Oct 2022
Abstract
Aim: Evaluate the diagnostic and prognostic performance of the ESC 0/1H Algorithm and its utility in safely discharging patients with suspected Acute Coronary Syndrome (ACS) in the Emergency Department.
Methods: This analysis is a retrospective cohort study of 3,156 patients presenting to an academic medical center emergency department (ED) between May 20, 2019 and May 31, 2020. Patients determined to have symptoms concerning for ACS who completed the Beckman Coulter Access High Sensitivity Troponin I (hs-TnI) assay per current institution protocol (T0, T1H, T3H) were retrospectively analyzed using the ESC 0/1H Algorithm to assess the safety and efficacy of a rule-out algorithm for early discharge.
Results: The negative predictive value (NPV) of the protocol (T0 < 6 pg/mL; or females with T0 ≤15 pg/mL and T1 ≤ 15pg/mL; or males with T0 ≤ 20 pg/mL and T1 ≤ 20 pg/mL) was 99.4% (95%C: 99.0-99.7%) for acute myocardial injury (AMI) at index and/or 30 day cardiac-related death. The negative likelihood ratio was 0.08 (95%CI: 0.05-0.13), and the specificity was 86.3% (95%CI: 85.0-87.5%).
Conclusion: The protocol was found to have a NPV greater than 99% and negative likelihood ratio of 0.08, suggesting it is safe to use for patients presenting to the ED with ACS symptoms no matter the time of symptom onset.
Keywords
High sensitivity troponin, emergency medicine, myocardial infarction Cite This Article
Perryman K, Winchester D, Massoomi M, Warren E, Morris L, Beal S, Radhakrishnan N, Ghaffar U, Sammon J, Raman J, Lewis M, Crabb D, Holtzman L, Allen B. Efficacy and safety of a 0/1-h high-sensitivity cardiac troponin I (hs-cTnI) protocol to rule out acute coronary syndrome over a one-year period. Vessel Plus 2022;6:[Accept]. http://dx.doi.org/10.20517/2574-1209.2022.34
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