Author + information
- Andrew R. Chapman,
- Atul Anand,
- Dennis Sandeman,
- Amy Ferry,
- Anoop Shah,
- Philip Adamson,
- Fiona Strachan,
- Alasdair Gray,
- David Newby and
- Nicholas Mills
Background: Novel pathways to rule out myocardial infarction utilize low concentrations of cardiac troponin to risk stratify patients. Whether use of additional clinical risk scores improves the safety of this approach is uncertain.
Methods: Patients with suspected acute coronary syndrome (n=1,139) underwent high-sensitivity cardiac troponin I testing at presentation, 3 and 6 or 12 hours. The HighSTEACS pathway rules out myocardial infarction in those without ischaemia on the ECG if troponin concentrations are <5 ng/L at presentation and symptom duration is ≥2 hours. Early presenters and those ≥5 ng/L are ruled out if absolute change is <3 ng/L at 3 hours and they remain ≤99th centile. We applied this pathway alone, or in combination with low risk HEART (≤3), GRACE (<110) or TIMI (0 or 1) scores. We compared the negative predictive value (NPV) and efficacy of each approach for a primary outcome of index type 1 myocardial infarction, or type 1 myocardial infarction or cardiac death at 30 days.
Results: The primary outcome occurred in 15.5% (177/1,139). The HighSTEACS pathway ruled out 61.9% (705/1,139) of patients with a NPV of 99.6% [95%CI 99.1-99.9%]. Restricting use of the pathway to those with low risk HEART, GRACE or TIMI scores did not improve safety (A) but significantly reduced efficacy (B).
Conclusions: The use of additional clinical risk scores does not improve the safety of a pathway applying ECG criteria and a risk stratification threshold, but significantly reduces the proportion eligible for discharge.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-350
- 2017 American College of Cardiology Foundation