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Am J Emerg Med. 2019 Aug 30. pii: S0735-6757(19)30557-1. doi: 10.1016/j.ajem.2019.158420. [Epub ahead of print]

Performance of cardiac troponins within the HEART score in predicting major adverse cardiac events at the emergency department.

Author information

1
Department of Cardiology, National Heart Centre Singapore, Singapore. Electronic address: jack.tan.w.c@singhealth.com.sg.
2
Department of Internal Medicine, SingHealth, Singapore.
3
Department of Cardiology, National Heart Centre Singapore, Singapore. Electronic address: anders.olof.sahlen@singhealth.com.sg.
4
Department of Cardiology, National Heart Centre Singapore, Singapore. Electronic address: yeo.khung.keong@singhealth.com.sg.
5
Department of Cardiology, National Heart Centre Singapore, Singapore. Electronic address: calvin.chin.w.l@singhealth.com.sg.
6
National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore. Electronic address: gao.fei@singhealth.com.sg.
7
Department of Emergency Medicine, Singapore General Hospital, Singapore. Electronic address: marcus.ong.e.h@singhealth.com.sg.
8
Department of Clinical Pathology, Singapore General Hospital, Singapore. Electronic address: yeo.chin.pin@singhealth.com.sg.
9
Department of Clinical Pathology, Singapore General Hospital, Singapore. Electronic address: ng.wai.yoong@sgh.com.sg.
10
Department of Emergency Medicine, Singapore General Hospital, Singapore. Electronic address: lim.swee.han@singhealth.com.sg.

Abstract

BACKGROUND:

This study compared the performance of a single blood draw of high-sensitivity troponin T (hsTnT), high-sensitivity troponin I (hsTnI) and conventional troponin I (cTnI) within a modified HEART score for predicting 30-day MACE at Emergency Department (ED) presentation, and established local reference norms for all three assays by determining the cut-off point which yielded the highest sensitivity and negative predictive value for acute myocardial infarction and 30-day MACE.

METHODS:

This single-center prospective cohort study recruited chest pain patients at the ED, whose hsTnT, hsTnI and cTnI were taken on admission. Subjects were classified into low and non-low risk group according to their modified HEART score, with MACE as the primary endpoint. Receiver-operating characteristic (ROC) curves were generated, area under the curves (AUCs) were calculated; the performance characteristics were determined.

RESULTS:

The performance of modified HEART scores was comparable among the three assays for 30-day MACE (84.9-87.0% sensitivity, 95.6-96.0% NPV, 95%CI) and none of these had very high AUC and specificity (AUC 0.70-0.71, 53.7-56.7% specificity, 95% CI). The modified HEART score using a single blood draw of either hsTnT (3.9ng/L), hsTnI (0.9ng/L) or cTnI (0.0ng/L) at presentation yielded a sensitivity of 100% for 30-day MACE.

CONCLUSION:

The modified HEART score using a single blood draw of either hsTnT, hsTnI or cTnI was equally effective in risk-stratifying chest pain patients for safe discharge. The theoretical cut-off points yielding 100% sensitivity are potentially useful (when achieved) for safely discharging low risk patients with undifferentiated chest pain in the ED.

KEYWORDS:

Acute coronary syndrome; Acute myocardial infarction; Emergency department; HEART score; High-sensitivity cardiac troponin; Major adverse cardiac event

PMID:
31493982
DOI:
10.1016/j.ajem.2019.158420

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