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2015 ; 101
(13
): 1041-6
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A novel diagnostic protocol to identify patients suitable for discharge after a
single high-sensitivity troponin
#MMPMID25691511
Carlton EW
; Cullen L
; Than M
; Gamble J
; Khattab A
; Greaves K
Heart
2015[Jul]; 101
(13
): 1041-6
PMID25691511
show ga
OBJECTIVE: To establish whether a novel accelerated diagnostic protocol (ADP) for
suspected acute coronary syndrome (ACS) could successfully identify low-risk
patients suitable for discharge after a single high-sensitivity troponin T
(hs-cTnT) taken at presentation to the emergency department. We also compared the
diagnostic accuracy of this ADP with strategies using initial undetectable
hs-cTnT. METHODS: This prospective observational study evaluated the ability of
the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify
low-risk patients with suspected ACS. The ADP incorporated a single presentation
hs-cTnT of <14?ng/L, a non-ischaemic ECG and a modified Goldman risk score.
Diagnostic performance of the ADP was compared with the detection limit cut-offs
of hs-cTnT (<5?ng/L and <3?ng/L). The primary end point was fatal/non-fatal acute
myocardial infarction (AMI) within 30?days. RESULTS: 960 participants were
recruited, mean age 58.0?years, 80 (8.3%) had an AMI. The TRUST ADP classified
382 (39.8%) as low-risk with a sensitivity for identifying AMI of 98.8% (95% CI
92.5% to 99.9%). hs-cTnT detection limits (<5?ng/L and <3?ng/L) had a sensitivity
of 100% (94.3 to 100) and 100% (94.4 to 100), respectively. The TRUST ADP
identified more patients suitable for early discharge at 39.8% vs 29.3% (<5?ng/L)
and 7.9% (<3?ng/L) (p<0.001) with a lower false-positive rate for AMI detection;
specificity 43.3% (95% CI 42.7% to 43.4%) vs 32.0% (95% CI 31.5% to 32.0%) and
8.6% (95% CI 8.1% to 8.6%), respectively. CONCLUSIONS: The TRUST ADP, which
incorporates structured risk-assessment and a single presentation hs-cTnT blood
draw, has potential to allow early discharge in 40% of patients with suspected
ACS and has greater clinical utility than undetectable hs-cTnT strategies. TRIAL
REGISTRATION NUMBER: ISRCTN No. 21109279.
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