Rapid and safe discharge from the emergency department: A single troponin to exclude acute myocardial infarction

Background Our study addressed the diagnostic performance of the Atellica® IM High-Sensitivity Troponin I (hs-cTnI) assay for the rapid rule-out of myocardial infarction (MI) using a single hs-cTnI measurement at presentation in patients presenting to a US emergency department (ED). Methods This was a prospective, observational, cohort study of consecutive ED patients with suspected acute coronary syndrome, using 12-lead electrocardiogram and serial hs-cTnI measurements ordered on clinical indication (SAFETY, NCT04280926). ST-segment elevation MI patients were excluded. The optimal threshold required a sensitivity ≥99% and a negative predictive value (NPV) ≥99.5% for MI during index hospitalization as primary outcome. Type 1 MI (T1MI), myocardial injury, and 30-day adverse events were considered secondary outcomes. Event adjudications were established using the hs-cTnI assay used in clinical care. Results In 1171 patients, MI occurred in 97 patients (8.3%), 78.3% of which were type 2 MI. The optimal rule out hs-cTnI threshold was <10 ng/L, which identified 519 (44.3%) patients as low risk at presentation, with sensitivity of 99.0% (95% CI, 94.4–100) and NPV of 99.8% (95% CI, 98.9–100). For T1MI, sensitivity was 100% (95% CI, 83.9–100) and NPV 100% (95% CI, 99.3–100). Regarding myocardial injury, the sensitivity and NPV were 99.5% (95% CI, 97.9–100) and 99.8% (95% CI, 98.9–100), respectively. For 30-day adverse events, sensitivity was 96.8% (95% CI, 94.3–98.4) and NPV 97.9% (95% CI, 96.2–98.9). Conclusions A single hs-cTnI measurement strategy enabled the rapid identification of patients at low risk of MI and 30-day adverse events, allowing potential discharge early after ED presentation. Clinicaltrials.gov Registration number NCT04280926.

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Rapid and safe discharge from the emergency department: A single troponin to exclude acute myocardial infarction

Abstract: This supports the utilisation of a rapid rule out strategy to exclude AMI for patients that have an initial HsTnI measurement <5 ng/L in conjunction with a robust risk assessment.

Cited by 5 publications

References 17 publications

Il tempo di risposta del Laboratorio (turnaround time, TAT) per la troponina (cTn). Raccomandazione del GdS MM SIPMeL

Il tempo di risposta del Laboratorio (turnaround time, TAT) per la troponina (cTn). Raccomandazione del GdS MM SIPMeL

High-sensitivity methods for cardiac troponins: The mission is not over yet

Rapid Rule-Out of Myocardial Infarction Using a Single High-Sensitivity Cardiac Troponin I Measurement Strategy at Presentation to the Emergency Department: The SAFETY Study

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