Publication: The utility of the 1-hour high-sensitivity cardiac troponin T algorithm compared with and combined with five early rule-out scores in high-acuity chest pain emergency patients
Issued Date
2020-01-01
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ISSN
18741754
01675273
01675273
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2-s2.0-85091882151
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Mahidol University
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SCOPUS
Bibliographic Citation
International Journal of Cardiology. (2020)
Suggested Citation
Onlak Ruangsomboon, Netiporn Thirawattanasoot, Tipa Chakorn, Chok Limsuwat, Apichaya Monsomboon, Nattakarn Praphruetkit, Usapan Surabenjawong, Sattha Riyapan, Tanyaporn Nakornchai The utility of the 1-hour high-sensitivity cardiac troponin T algorithm compared with and combined with five early rule-out scores in high-acuity chest pain emergency patients. International Journal of Cardiology. (2020). doi:10.1016/j.ijcard.2020.08.099 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/60118
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Title
The utility of the 1-hour high-sensitivity cardiac troponin T algorithm compared with and combined with five early rule-out scores in high-acuity chest pain emergency patients
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Abstract
© 2020 Elsevier B.V. Background: Although the 0/1 h high-sensitivity cardiac troponin T (0/1 hs-cTnT) algorithm and many risk scores have been validated for use in emergency departments (EDs), their utility in high-acuity ED patients has not been validated. We aimed to validate the 0/1 hs-cTnT algorithm and the HEART, TIMI, GRACE, T-MACS and NOTR risk scores before and after combining the 0/1 algorithm in high-acuity ED chest pain patients. Methods: A prospective observational study was conducted in the high-acuity ED of Siriraj Hospital, a tertiary hospital in Bangkok, Thailand. Adult patients with chest pain were enrolled between November 2018 and November 2019. The primary outcome was 30-day major adverse cardiac events (30-day MACE), defined as a composite of mortality, acute myocardial infarction, significant coronary stenosis and revascularization procedures. Results: Of 350 recruited patients, 59 (16.9%) developed 30-day MACE. For the 0/1 hs-cTnT algorithm, sensitivity and negative predictive value (NPV) were 91.3% (95%CI 79.2–97.6%) and 97.2% (95%CI 93.2–98.9%), respectively. Specificity and positive predictive value were 79.6% (95%CI 72.8–85.2%) and 53.9% (95%CI 46.2–61.3%), respectively. Of the risk scores, the HEART score had the highest area under the receiver operator characteristic curve (0.74 [95%CI 0.68–0.81]). Combining the 0/1 hs-cTnT algorithm, a TIMI score cut-off of ≤1 had the best sensitivity and NPV (both 100%) and identified the greatest proportion of patients (24.3%) suitable for safe discharge. Conclusion: The 0/1 hs-cTnT algorithm may be feasible in Asian high-acuity ED patients. The HEART score outperformed other scores in predicting 30-day MACE. Combining the 0/1 hs-cTnT algorithm with a TIMI cut-off score ≤ 1 had the best rule-out performance.