TY - JOUR
T1 - Use of the HEART Pathway with high sensitivity cardiac troponins
T2 - A secondary analysis
AU - Mahler, Simon A.
AU - Stopyra, Jason P.
AU - Apple, Fred S.
AU - Riley, Robert F.
AU - Russell, Gregory B.
AU - Hiestand, Brian C.
AU - Hoekstra, James W.
AU - Lefebvre, Cedric W.
AU - Nicks, Bret A.
AU - Cline, David M.
AU - Askew, Kim L.
AU - Herrington, David M.
AU - Burke, Gregory L.
AU - Miller, Chadwick D.
N1 - Publisher Copyright:
© 2017 The Canadian Society of Clinical Chemists
PY - 2017/5
Y1 - 2017/5
N2 - Objectives The HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve > 99% sensitivity for major adverse cardiac events (MACE) at 30 days and early discharge rates > 20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. Design & methods A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. Each patient was risk stratified by the cTn-HEART Pathway (Siemens TnI-Ultra at 0- and 3-h) and a hs-cTn-HEART Pathway using hs-cTnI (Abbott) or hs-cTnT (Roche) at 3-h. The early discharge rate, sensitivity, specificity, and negative predictive value (NPV) for MACE (death, myocardial infarction, or coronary revascularization) at 30 days were calculated. Results hs-cTnI measures were available on 133 patients. MACE occurred in 11/133 (8%) of these patients. Test characteristics for the HEART Pathway using serial cTnI vs 3 hour hs-cTnI were the same: sensitivity (100%, 95%CI: 72–100%), specificity (49%, 95%CI: 40–58%), NPV (100%, 95%CI: 94–100%), and early discharge rate (45%, 95%CI: 37–54%). The HEART Pathway using hs-cTnT missed one MACE event (myocardial infarction): sensitivity (91%, 95%CI: 59–100%), specificity (48%, 95%CI: 39–57%), NPV (98%, 95%CI: 91–100%), and early discharge rate (45%, 95%CI: 37–54%). Conclusions There was no difference in the test characteristics of the HEART Pathway whether using cTnI or hs-cTnI, with both achieving 100% sensitivity and NPV. Use of hs-cTnT with the HEART Pathway was associated with one missed MACE.
AB - Objectives The HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve > 99% sensitivity for major adverse cardiac events (MACE) at 30 days and early discharge rates > 20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. Design & methods A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. Each patient was risk stratified by the cTn-HEART Pathway (Siemens TnI-Ultra at 0- and 3-h) and a hs-cTn-HEART Pathway using hs-cTnI (Abbott) or hs-cTnT (Roche) at 3-h. The early discharge rate, sensitivity, specificity, and negative predictive value (NPV) for MACE (death, myocardial infarction, or coronary revascularization) at 30 days were calculated. Results hs-cTnI measures were available on 133 patients. MACE occurred in 11/133 (8%) of these patients. Test characteristics for the HEART Pathway using serial cTnI vs 3 hour hs-cTnI were the same: sensitivity (100%, 95%CI: 72–100%), specificity (49%, 95%CI: 40–58%), NPV (100%, 95%CI: 94–100%), and early discharge rate (45%, 95%CI: 37–54%). The HEART Pathway using hs-cTnT missed one MACE event (myocardial infarction): sensitivity (91%, 95%CI: 59–100%), specificity (48%, 95%CI: 39–57%), NPV (98%, 95%CI: 91–100%), and early discharge rate (45%, 95%CI: 37–54%). Conclusions There was no difference in the test characteristics of the HEART Pathway whether using cTnI or hs-cTnI, with both achieving 100% sensitivity and NPV. Use of hs-cTnT with the HEART Pathway was associated with one missed MACE.
KW - Acute coronary syndrome
KW - Chest pain
KW - HEART Pathway
KW - Troponin
UR - http://www.scopus.com/inward/record.url?scp=85009775137&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85009775137&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiochem.2017.01.003
DO - 10.1016/j.clinbiochem.2017.01.003
M3 - Article
C2 - 28087371
AN - SCOPUS:85009775137
SN - 0009-9120
VL - 50
SP - 401
EP - 407
JO - Clinical Biochemistry
JF - Clinical Biochemistry
IS - 7-8
ER -