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

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. After completing the Beckman Coulter Access High Sensitivity Troponin I (hs-TnI) assay per current institution protocol (T0, T1H, T3H), patients identified to have symptoms concerning ACS 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 ≤ 15 pg/mL; or males with T₀ ≤ 20 pg/mL and T₁ ≤ 20 pg/mL) was 99.4% (95%CI: 99.0-99.7%) for acute myocardial injury at the initial ED visit (index ED visit) 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 a 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

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