Author + information
- Deepak Kumar Sahu,
- Giacomo Basadonna and
- Michal Raciborski
Background: High-sensitive Troponin (hs-cTn) can rule-out Acute Myocardial Infarction (AMI) at early hours with high Negative Predictive Value (NPV), but low Positive Predictive Value (PPV) causing false positives with several patients (46.9%-54%) remaining under observation. We demonstrate that measuring hs-cTn at two different clinically accepted cut-offs, within the first 6 hours after emergency room (ER) presentation, will achieve significant cost savings by accurately diagnosing 99.3% of Non-ST Segment Elevation Myocardial Infarction (NSTEMI) patients.
Methods: This study investigates the health economic impact of modeling a novel algorithm of sequential measuring hs-cTn at two different cut-offs points ((A) Limit of Detection (LOD),ng/L – 1.1-1.9, 99th Percentile, ng/L – 19.3, (B) LOD, ng/L – 9, 99th Percentile, ng/L – 28 ng/L) in 1,000 NSTEMI patients presenting to ER with chest pain. A prevalence of 17.5% AMI was considered (meta-analysis 99% CI 12.5%-22.5%). Test A is used to first identify True Negatives. Test B is used to detect True Positives. A total of 6 tests are done with clinical decisions taken at 1, 3, 4 and 6 Hrs.
Conclusions: This novel diagnostic protocol can achieve a PPV of 96% and NPV of 98.8%, leaving only 6.7% patients under observation beyond 6 Hrs. It promotes significant cost savings when compared to using either only hs-cTn 1 Hr. rule-out or conventional troponin 12-18 Hr.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-345
- 2017 American College of Cardiology Foundation