Utility of High-Sensitivity Troponin Among Stable Patients With Chest Pain Undergoing Stress Imaging (from PROMISE)

Abstract Background NSTEMI may be ruled out in patients presenting with acute chest pain based on low baseline high sensitivity troponin (cTn) at admission. This procedure is limited by a low expected frequency of ruled out non-cardiac chest pain (NCCP) patients. Purpose To investigate if stress-induced biomarkers (glucose or copeptin) combined with cTn can increase the rate of NCCP ruled out without an unacceptable increase in incorrectly ruled out NSTEMI. Method 971 patients with suspected NSTE-ACS were included. Final diagnosis was adjudicated by two independent cardiologists using clinical data including routine cTnT. Additionally, baseline cTnI, cTnI from Singulex Clarity System (cTnI(sgx)), copeptin and glucose were measured. Diagnostic performance to rule out NSTEMI was compared between the ESC rule out algorithms for cTnT and cTnI(Abbott), a local cTnI(sgx) algorithm and different combinations of cTn with copeptin or glucose Results Median age 61 years, 60% male. 13% had NSTEMI, 12% had UAP and 60% NCCP. Distribution of copeptin and glucose concentrations (NSTEMI and NCCP) is shown in figure 1. Copeptin and cTnT produces an algorithm with lower miss rate for NSTEMI, increased rule out rate for NCCP and significantly higher AUC (DeLong test, p value <0.001) compared to the ESC algorithm (Table 1). cTnI(sgx) and copeptin showed higher rule out for NCCP and higher AUC (p value <0.001), however an increased rule out rate for NSTEMIs. Combining cTnI(Abbott) and glucose gave a similar miss rate for NSTEMI as ESC, but increased rule out rate for NCCP and higher AUC (p value <0.001). Conclusion Combining cTnT or cTnI(sgx) with copeptin; or cTnI with glucose, improves diagnostic precision and efficacy of rule out protocols for NSTEMI in patients presenting with acute chest pain. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Western Norway Regional Health Authority; Haukeland and Stavanger University Hospitals

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Comparison Between Soluble ST2 and High-Sensitivity Troponin I in Predicting Short-Term Mortality for Patients Presenting to the Emergency Department With Chest Pain

Annals of Laboratory Medicine ◽

10.3343/alm.2017.37.2.137 ◽

2017 ◽

Vol 37 (2) ◽

pp. 137-146 ◽

Cited By ~ 11

Author(s):

Rossella Marino ◽

Laura Magrini ◽

Francesca Orsini ◽

Veronica Russo ◽

Patrizia Cardelli ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Troponin I ◽

High Sensitivity ◽

Short Term ◽

Soluble St2 ◽

High Sensitivity Troponin ◽

Short Term Mortality

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Validation of an accelerated high‐sensitivity troponin T assay protocol in an Australian cohort with chest pain

The Medical Journal of Australia ◽

10.5694/mja13.10466 ◽

2014 ◽

Vol 200 (3) ◽

pp. 161-165 ◽

Cited By ~ 10

Author(s):

William A Parsonage ◽

Jaimi H Greenslade ◽

Christopher J Hammett ◽

Arvin Lamanna ◽

Jillian R Tate ◽

...

Keyword(s):

Chest Pain ◽

Troponin T ◽

High Sensitivity ◽

High Sensitivity Troponin ◽

Australian Cohort ◽

High Sensitivity Troponin T ◽

Assay Protocol

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Randomised controlled trial of the Limit of Detection of Troponin and ECG Discharge (LoDED) strategy versus usual care in adult patients with chest pain attending the emergency department: study protocol

BMJ Open ◽

10.1136/bmjopen-2018-025339 ◽

2018 ◽

Vol 8 (10) ◽

pp. e025339 ◽

Cited By ~ 4

Author(s):

Edward Carlton ◽

Sarah Campbell ◽

Jenny Ingram ◽

Rebecca Kandiyali ◽

Hazel Taylor ◽

...

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Randomised Controlled Trial ◽

Limit Of Detection ◽

Controlled Trial ◽

High Sensitivity ◽

Early Discharge ◽

High Sensitivity Troponin ◽

Randomised Controlled ◽

Rule Out

IntroductionObservational data suggest a single high-sensitivity troponin blood test taken at emergency department (ED) presentation could be used to rule out major adverse cardiac events (MACE) in 10%–60% of ED patients with chest pain. This is done using an ‘undetectable’ cut-off (the Limit of Detection: LoD). We combined the LoD cut-off with ECG findings to create the LoDED strategy. We aim to establish whether the LoDED strategy works under real-life conditions, when compared with existing strategies, in a way that is cost-effective and acceptable to patients.Methods and analysisThis is a parallel-group pragmatic randomised controlled trial across UK EDs. Adults presenting to ED with suspected cardiac chest pain will be randomised 1:1. Existing rule-out strategies in current use across study centres, using serial high-sensitivity troponin testing, will be compared with the LoDED strategy. The primary outcome is successful early discharge (discharge from hospital within 4 hours of arrival) without MACE occurring within 30 days. Secondary outcomes include initial length of hospital stay; comparative costs; patient satisfaction and acceptability to patients. To detect a 9% difference between the early discharge rates (assuming an 8% rate in the standard care group) with 90% power, 594 patients need to be recruited, assuming a 95% follow-up rate.Ethics and disseminationThe study has been approved by the Frenchay Research Ethics Committee (reference 18/SW/0038). Results will be published in an international peer-reviewed journal. Lay summaries will be made available to patients.Trial registration numberISRCTN86184521; Pre-results.

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