Journal article
Assessment of the 2016 National Institute for Health and Care Excellence high-sensitivity troponin rule-out strategy
Heart, Vol.104(8), pp.665-672
2018
Abstract
Objective: We aimed to evaluate the limit of detection of high-sensitivity troponin (hs-cTn) and Thrombolysis In Myocardial Infarction (TIMI) score combination rule-out strategy suggested within the 2016 National Institute for Health and Care Excellence (NICE) Chest Pain of Recent Onset guidelines and establish the optimal TIMI score threshold for clinical use. Methods: A pooled analysis of adult patients presenting to the emergency department with chest pain and a non-ischaemic ECG, recruited into six prospective studies, from Australia, New Zealand and the UK. We evaluated the sensitivity of TIMI score thresholds from 0 to 2 alongside hs-cTnT or hs-cTnI for the primary outcome of major adverse cardiac events within 30 days. Results: Data were available for 3159 patients for hs-cTnT and 4532 for hs-cTnI, of these 376 (11.9%) and 445 (9.8%) had major adverse cardiac events, respectively. Using a TIMI score of 0, the sensitivity for the primary outcome was 99.5% (95% CI 98.1% to 99.9%) alongside hs-cTnT and 98.9% (97.4% to 99.6%)%) alongside hs-cTnI, identifying 17.9% and 21.0% of patients as low risk, respectively. For a TIMI score ≤1 sensitivity was 98.9% (97.3% to 99.7%)%) alongside hs-cTnT and 98.4% (96.8% to 99.4%)%) alongside hs-cTnI, identifying 28.1% and 35.7% as low risk, respectively. For TIMI≤2, meta-sensitivity was < 98% with either assay. Conclusions: Our findings support the rule-out strategy suggested by NICE. The TIMI score threshold suggested for clinical use is 0. The proportion of patients identified as low risk (18%-21%) and suitable for early discharge using this threshold may be sufficient to encourage change of practice.
Details
- Title
- Assessment of the 2016 National Institute for Health and Care Excellence high-sensitivity troponin rule-out strategy
- Authors
- Edward Watts Carlton (Author) - University of Otago, New ZealandJohn William Pickering (Author) - Royal Brisbane and Women's Hospital, BrisbaneJaimi Greenslade (Author) - Christchurch Hospital, New ZealandLouise Cullen (Author) - Christchurch Hospital, New ZealandMartin Than (Author) - University of QueenslandJason Kendall (Author) - University of Otago, New ZealandRichard Body (Author) - Bournemouth University, United KingdomWilliam A Parsonage (Author) - Christchurch Hospital, New ZealandAhmed Khattab (Author) - Bournemouth University, United KingdomKim Greaves (Author) - University of the Sunshine Coast
- Publication details
- Heart, Vol.104(8), pp.665-672
- Publisher
- B M J Group
- Date published
- 2018
- DOI
- 10.1136/heartjnl-2017-311983
- ISSN
- 1355-6037
- Copyright note
- Copyright © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
- Organisation Unit
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast, Queensland
- Language
- English
- Record Identifier
- 99451289902621
- Output Type
- Journal article
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