Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

作者：Mahler Simon A^*; Stopyra Jason P; Apple Fred S; Riley Robert F; Russell Gregory B; Hiestand Brian C; Hoekstra James W; Lefebvre Cedric W; Nicks Bret A; Cline David M; Askew Kim L; Herrington David M; Burke Gregory L; Miller Chadwick D

来源：Clinical Biochemistry, 2017, 50(7-8): 401-407.

DOI：10.1016/j.clinbiochem.2017.01.003

• Troponin
• Chest pain
• Acute coronary syndrome
• HEART Pathway

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-cTnHEART 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%Cl: 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%Cl: 39-57%), NPV (98%, 95%Cl: 91-100%), and early discharge rate (45%, 95%Cl: 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.

• 出版日期2017-5