High-Sensitivity Troponin Rapid Rule-Out Protocol in the U.S.

Written by Clay Smith

Spoon Feed
Use of a rapid rule-out MI protocol with hs-cTnT was safe, accurate, and would have reduced time to discharge and increased the proportion of patients ruled out in this U.S.-based implementation study.

Why does this matter?
Europe has been using high sensitivity troponin for quite some time.  But the U.S. has only recently gotten FDA approval.  How would such a protocol fare in the U.S.?

Head 'em up - rule 'em out
This was a prospective observational study at a single center with 563 patients presenting to the ED with need for MI rule-out.  They compared hs-cTnT to standard troponin rule-out at 0 and 3 hours using a rapid rule out protocol (see figure).  Adjudicated MI prevalence was 2.1%.  More than half would have been ruled out at one hour with the new protocol.  Sensitivity and NPV were both 100% for the hs-cTnT assay, though with wide confidence intervals.  This is a promising protocol in a U.S. ED population and will need subsequent study to validate and implement safely.  I really like this protocol because often patients have slightly elevated troponin levels with the high sensitivity assays.  This protocol considers change in hs-cTnT from baseline to 1-hour and 1-hour to 3-hour, allowing classification as "ruled out" or "abnormal", needing more workup as opposed to the ESC 0/1 Algorithm limbo "Observe" category.

 
 From cited article

From cited article

 

Source
Evaluation of a Novel Rule-Out Myocardial Infarction Protocol Incorporating High-Sensitivity Troponin T in a US Hospital Circulation. 2018;138:00–00. DOI: 10.1161/CIRCULATIONAHA.118.033861

Another Spoonful
Props to JWatch for covering this.  Subscription required.

Reviewed by Thomas Davis

Member Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Member Area
My Profile Sign up to get full access. Log Out