A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: Design of the Rapid Assessment of Possible ACS In the emergency Department with high sensitivity Troponin T (RAPID-TnT) study

Papendick, Cynthia; Blyth, Andrew; Seshadri, Anil; Edmonds, Michael J R; Briffa, Tom; Cullen, Louise; Quinn, Stephen; Karnon, Jonathan; Chuang, Anthony; Nelson, Adam; Horsfall, Matthew; Morton, Erin; Chew, Derek P.

doi:10.1016/j.ahj.2017.05.004

Cited by 21 publications

(14 citation statements)

References 19 publications

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“…Troponin detection exerts a great influence on clinical decision‐making. More sensitive troponin assays have the potential to better evaluate the patients with suspected ACS presenting to the emergency department (ED), allowing for earlier safe discharge of low‐risk chest pain and earlier recognition of AMI . Conventional troponin assays could lead to an inappropriate discharge, while more sensitive troponin assays may result in avoidable diagnostic testing.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of using a more sensitive troponin assay in patients with acute chest pain

Wang

et al. 2019

Clinical Cardiology

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Background More sensitive troponin assays have the potential to better evaluate patients with suspected acute coronary syndrome (ACS). Meanwhile, they may result in avoidable diagnostic testing. Hypothesis Our aim was to determine the clinical impact of implementing a more sensitive cardiac troponin I (cTnI) assay in patients with acute non‐traumatic chest pain presenting to the emergency department (ED). Methods This is a pre‐post cohort study. A total of 1201 consecutive patients with acute non‐traumatic chest pain or equivalent ischemic symptoms suggestive of ACS were allocated to two groups according to the cTnI assay used. The outcomes included the ED length of stay (LOS), hospital admission rate, the use of procedures and the incidence of major adverse cardiac events (MACE) at 30 days. Results The introduction of the more sensitive troponin assay shortened ED LOS (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.28‐0.54) regarding patients discharged home directly, increased the hospital admission rate (OR 1.43, 95% CI 1.12‐1.84), the use of echocardiography (OR 1.58, 95% CI 1.22‐2.06), coronary computed tomography angiography (OR 1.78, 95% CI 1.04‐3.06), coronary angiography (OR 1.53, 95% CI 1.10‐2.12) and percutaneous coronary intervention (OR 2.42, 95% CI 1.58‐3.70) regarding patients discharged or admitted. The incidence of MACE did not decrease significantly (OR 0.61, 95% CI 0.27‐1.37). Conclusions The introduction of the more sensitive troponin assay appeared to result in less time spent in the ED regarding patients discharged home directly, but prompted more hospitalizations and procedures without impacting the incidence of MACE.

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Section: Introductionmentioning

confidence: 99%

Clinical impact of using a more sensitive troponin assay in patients with acute chest pain

Wang

et al. 2019

Clinical Cardiology

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“…All troponin samples were analysed using 5 th generation hs-cTnT assay (Roche Diagnostics: lower limit of quantification: 5ng/L; 99th percentile upper reference limit in a normal population: male = �22ng/L, PLOS ONE female = �14ng/L; lowest concentration with a coefficient of variation <10%: 4.49 ng/L). During the study period, an elevated troponin was only reported to the treating clinician at a hs-cTnT concentration �29ng/L due to previous and ongoing studies [26,27]. A clinically significant rise and/or fall was determined as a relative change of �20% or a gradient of �3ng/L/hr from initial to any subsequent measurement within 24 hours as per expert consensus and existing literature [2,28].…”

Section: Biomarker Measurementsmentioning

confidence: 99%

Troponin elevation pattern and subsequent cardiac and non-cardiac outcomes: Implementing the Fourth Universal Definition of Myocardial Infarction and high-sensitivity troponin at a population level

et al. 2021

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Background The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury. Methods We included all patients presenting to public emergency departments in South Australia between June 2011–Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia. Results 372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia. Conclusions Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research.

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“…9 Establishing protocols for the incorporation of this assay into current practice and further research assessing its effect on patient care and health care systems will improve the use of hs-cTnT. 10 Editor's Note: This is a clinical synopsis, a regular feature of the Annals' Systematic Review Snapshot (SRS) series. The source for this systematic review snapshot is: Michael Brown, MD, MSc, Jestin N. Carlson, MD, MS, and Alan Jones, MD, serve as editors of the SRS series.…”

Section: Commentarymentioning

confidence: 99%

Can a Negative High-Sensitivity Troponin Result Rapidly Rule Out Acute Myocardial Infarction?

Finnerty

Weinstock

2018

Annals of Emergency Medicine

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A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: Design of the Rapid Assessment of Possible ACS In the emergency Department with high sensitivity Troponin T (RAPID-TnT) study

Abstract: Demonstrating that a 0/1-hour hs-TnT protocol improves the effectiveness and efficiency of care within a robust comparative study will fill an evidence gap that currently limits the translation of more precise hs-TnT testing into better patient and health service outcomes.

Cited by 21 publications

References 19 publications

Clinical impact of using a more sensitive troponin assay in patients with acute chest pain

Clinical impact of using a more sensitive troponin assay in patients with acute chest pain

Troponin elevation pattern and subsequent cardiac and non-cardiac outcomes: Implementing the Fourth Universal Definition of Myocardial Infarction and high-sensitivity troponin at a population level

Can a Negative High-Sensitivity Troponin Result Rapidly Rule Out Acute Myocardial Infarction?

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