James McCord1, Rafael Cabrera2, Bertil Lindahl2, Evangelos Giannitsis2, Kaleigh Evans2, Richard Nowak2, Tiberio Frisoli2, Richard Body2, Michael Christ2, Christopher R deFilippi2, Robert H Christenson2, Gordon Jacobsen2, Aitor Alquezar2, Mauro Panteghini2, Dina Melki2, Mario Plebani2, Franck Verschuren2, John French2, Garnet Bendig2, Silvia Weiser2, Christian Mueller2. 1. From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.). jmccord1@hfhs.org. 2. From the Henry Ford Heart & Vascular Institute (J.M., R.C., T.F.), Department of Emergency Medicine (R.N.), and Department of Public Health Sciences (G.J.), Henry Ford Health System, Detroit, MI; Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Sweden (B.L.); Department of Internal Medicine III, Cardiology, Angiology & Pulmonology, University Hospital Heidelberg, Germany (E.G.); Department of Internal Medicine, Henry Ford Hospital Health System, Detroit, MI (K.E.); Central Manchester University Hospitals NHS Foundation Trust, United Kingdom (R.B.); Department of Emergency and Critical Care Medicine, General Hospital, Paracelsus Medical University, Nuremberg, Germany (M.C.); Department of Medicine, Inova Heart and Vascular Institute, Falls Church, VA (C.R.d.); Department of Pathology, University of Maryland School of Medicine, Baltimore (R.H.C.); Department of Emergency Medicine, Hospital de Sant Pau, Barcelona, Spain (A.A.); Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan Medical School, Milano, Italy (M. Panteghini); Department of Medicine, Huddinge, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (D.M.); Department of Laboratory Medicine, University Hospital of Padova, Padua, Italy (M. Plebani); Cliniques Universitaires St-Luc and Universite Catholique de Louvain, Brussels, Belgium (F.V.); Liverpool Hospital and University of New South Wales, Sydney, Australia (J.F.); Roche Diagnostics Germany, Penzberg, Germany (G.B., S.W.); and Cardiology & Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (C.M.).
Abstract
BACKGROUND: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. METHODS AND RESULTS: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03). CONCLUSIONS: Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.
BACKGROUND: The TRAPID-AMI trial study (High-Sensitivity Troponin-T Assay for Rapid Rule-Out of Acute Myocardial Infarction) evaluated high-sensitivity cardiac troponin-T (hs-cTnT) in a 1-hour acute myocardial infarction (AMI) exclusion algorithm. Our study objective was to evaluate the prognostic utility of a modified HEART score (m-HS) within this trial. METHODS AND RESULTS: Twelve centers evaluated 1282 patients in the emergency department for possible AMI from 2011 to 2013. Measurements of hs-cTnT (99th percentile, 14 ng/L) were performed at 0, 1, 2, and 4 to 14 hours. Evaluation for major adverse cardiac events (MACEs) occurred at 30 days (death or AMI). Low-risk patients had an m-HS≤3 and had either hs-cTnT<14 ng/L over serial testing or had AMI excluded by the 1-hour protocol. By the 1-hour protocol, 777 (60%) patients had an AMI excluded. Of those 777 patients, 515 (66.3%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 262 (33.7%) patients had an m-HS≥4, with 6 (2.3%) patients having MACEs (P=0.007). Over 4 to 14 hours, 661 patients had a hs-cTnT<14 ng/L. Of those 661 patients, 413 (62.5%) patients had an m-HS≤3, with 1 (0.2%) patient having a MACE, and 248 (37.5%) patients had an m-HS≥4, with 5 (2.0%) patients having MACEs (P=0.03). CONCLUSIONS: Serial testing of hs-cTnT over 1 hour along with application of an m-HS identified a low-risk population that might be able to be directly discharged from the emergency department.
Authors: Paul I Musey; Fernanda Bellolio; Suneel Upadhye; Anna Marie Chang; Deborah B Diercks; Michael Gottlieb; Erik P Hess; Michael C Kontos; Bryn E Mumma; Marc A Probst; John H Stahl; Jason P Stopyra; Jeffrey A Kline; Christopher R Carpenter Journal: Acad Emerg Med Date: 2021-07-06 Impact factor: 5.221
Authors: Tonje R Johannessen; Dan Atar; Odd Martin Vallersnes; Anne Cecilie K Larstorp; Ibrahimu Mdala; Sigrun Halvorsen Journal: BMJ Open Date: 2021-02-24 Impact factor: 2.692