Algorithm for probable acute coronary syndrome using high-sensitivity troponin T assay vs fourth-generation troponin
Diego Conde1, Juan Pablo Costabel, Florencia Lambardi
1Chief of Cardiovascular Emergency Care Section, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. drconde@hotmail.com
Insights
The high-sensitivity troponin T assay (HSTT) algorithm in chest pain units offers the same accuracy as the fourth-generation troponin T assay (4GTT) for diagnosing acute coronary syndrome, significantly reducing emergency department length of stay.
Area of Science:
- Cardiology
- Emergency Medicine
- Biomarker Assays
Background:
- Chest pain accounts for 5-10% of emergency department visits and 25% of hospitalizations.
- Accurate characterization of chest pain is crucial to prevent misdiagnosis of acute coronary syndrome.
- Current strategies aim to improve the diagnostic accuracy in chest pain units.
Purpose of the Study:
- To compare the negative predictive value of chest pain unit algorithms using fourth-generation troponin T assay (4GTT) versus high-sensitivity troponin T assay (HSTT).
- To evaluate the efficiency of HSTT in reducing emergency department (ED) length of stay.
Main Methods:
- A study involving 600 patients with suspected acute coronary syndrome was conducted.
- Patients were divided into two groups: 300 using 4GTT and 300 using HSTT.
- Clinical data and laboratory variables were analyzed, with a 30-day follow-up for cardiovascular events.
Main Results:
- No significant difference in major cardiac events between the HSTT (1.2%) and 4GTT (1.7%) groups.
- Both assays demonstrated a negative predictive value of 99%.
- ED length of stay was significantly shorter with HSTT (4.3 hours) compared to 4GTT (10 hours).
Conclusions:
- The HSTT algorithm in chest pain units has equivalent negative predictive value to the 4GTT algorithm.
- Utilizing HSTT significantly reduces emergency department length of stay.
- HSTT offers a more efficient diagnostic approach for patients presenting with chest pain.
Background:
Chest pain represents between 5% and 10% of annual visits to emergency departments (EDs) and near 25% of hospitalizations. Characterization of chest pain is sometimes difficult, and strategies should focus on preventing inappropriate discharge of patients with acute coronary syndrome. The goal of our study is to compare negative predictive value of the algorithm in the chest pain unit using the fourth-generation troponin T assay (4GTT) vs high-sensitivity troponin T assay (HSTT).
Methods:
We included 600 patients with probable acute coronary syndrome, who were discharged from the chest pain unit without an acute coronary syndrome: 300 patients in the 4GTT group and 300 patients in the HSTT group. Clinical and laboratory variables were analyzed. All the patients were followed up at 30 days, and the cardiovascular events were recorded.
Results:
Major cardiac events occurred in only 3 (1.2%) in the HSTT group vs 5 (1.7%) in the 4GTT group (P, nonsignificant). The negative predictive value was 99% in both groups. Emergency department length of stay was 4.3 ± 2.6 hours in HSTT group vs 10 ± 3.4 hours in the 4GTT group (P = .01).
Conclusion:
The algorithm in the chest pain unit using HSTT showed to have the same negative predictive value as the algorithm with the 4GTT but with a shorter stay in the ED.
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