Performance of the 0/2-Hour hs-cTnT Accelerated Diagnostic Protocol in a Multisite United States Cohort
Authors: Michael W Supples, Anna C Snavely, Nicklaus P Ashburn, Brandon R Allen, Robert H Christenson, Richard Nowak, R Gentry Wilkerson, Bryn E Mumma, Troy Madsen, Jason P Stopyra, Simon A Mahler
Published in: Academic Emergency Medicine, 2023 November 5
Conclusions:
- The hs-cTnT 0/2-hour algorithm alone ruled out a majority of patients, but with an NPV of less than 99%, it might not be considered sufficiently safe by some ED physicians in the U.S. for determining 30-day cardiac death or MI.
- However, combining the algorithm with the HEAR score increased the NPV over 99% for 30-day CDMI, though it did so at the expense of ruling out fewer patients.
Methods:
- The study was a pre-planned subgroup analysis of the STOP-CP cohort, enrolling patients from January 2017 to September 2018 across eight U.S. EDs.
- Patients were classified into rule-out, observation, and rule-in categories using the hs-cTnT 0/2-hour algorithm, both alone and with the History, ECG, Age, and Risk Factor (HEAR) score.
- The main measure was 30-day cardiac death or myocardial infarction (CDMI).
- Sensitivity, negative predictive value (NPV), specificity, and positive predictive value (PPV) were assessed.
Results:
- 1307 patients participated: 53.6% male, 58.6% white, average age 57.5 years.
- CDMI occurred in 12.9% of patients within 30 days.
- The 0/2-hour algorithm:
- Ruled-out 61.4% of patients.
- Among ruled-out, 1.9% experienced CDMI, yielding 91.1% sensitivity and 98.1% NPV.
- Ruled-in 12.4% of patients, with 61.7% experiencing CDMI, yielding 94.6% specificity and 61.7% PPV.
- When combined with HEAR score:
- Ruled-out 30.7% with a sensitivity of 98.2% and NPV of 99.3% for 30-day CDMI.