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Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Simon A Mahler1, Jason P Stopyra1, Fred S Apple2

  • 1Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Clinical Biochemistry
|January 15, 2017
PubMed

Insights

The HEART Pathway demonstrates 100% sensitivity for major adverse cardiac events (MACE) when using either cardiac troponin I (cTnI) or high-sensitivity troponin I (hs-cTnI). High-sensitivity troponin T (hs-cTnT) was associated with a missed MACE event.

Area of Science:

  • Cardiology
  • Biomarker Analysis
  • Clinical Diagnostics

Background:

  • The HEART Pathway utilizes cardiac troponin I (cTnI) for early detection of major adverse cardiac events (MACE).
  • Integration of high-sensitivity troponin (hs-cTn) assays into the HEART Pathway requires evaluation.

Purpose of the Study:

  • To compare the diagnostic performance of the HEART Pathway using high-sensitivity troponin I (hs-cTnI), high-sensitivity troponin T (hs-cTnT), and conventional cTnI.
  • To assess early discharge rates and test characteristics for MACE within 30 days.

Main Methods:

  • Secondary analysis of a HEART Pathway randomized controlled trial cohort.
  • Risk stratification using serial cTnI (Siemens TnI-Ultra) and 3-hour hs-cTnI (Abbott) or hs-cTnT (Roche).
  • Calculation of sensitivity, specificity, negative predictive value (NPV), and early discharge rate for MACE.

Main Results:

  • No significant difference in test characteristics between cTnI and hs-cTnI HEART Pathway protocols; both achieved 100% sensitivity and NPV.
  • hs-cTnI and cTnI protocols yielded identical specificity (49%) and early discharge rates (45%).
  • The hs-cTnT HEART Pathway protocol resulted in one missed MACE event (myocardial infarction), with 91% sensitivity and 98% NPV.

Conclusions:

  • The HEART Pathway maintains excellent test characteristics, including 100% sensitivity and NPV, when employing hs-cTnI instead of cTnI.
  • Use of hs-cTnT in the HEART Pathway is associated with a potential reduction in sensitivity for detecting MACE.
  • Both cTnI and hs-cTnI are suitable for the HEART Pathway, supporting early patient discharge while ensuring high sensitivity for MACE.
Abstract

Keywords:
Acute coronary syndromeChest painHEART PathwayTroponin

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