The utility of risk scores when evaluating for acute myocardial infarction using high-sensitivity cardiac troponin I - 25/08/20
, Christopher deFilippi, MD b, Frank Peacock, MD c, Simon Mahler, MD d, Richard Nowak, MD e, Robert Christenson, PhD f, Fred Apple, PhD g, Gordon Jacobsen, MS h, James McCord, MD aBackground |
Risk scores including the Thrombolysis in Myocardial Infarction (TIMI) score; History, Electrocardiogram, Age, Risk Factors, and Troponin (HEART) score; and Simplified Emergency Department Assessment of Chest Pain Score (sEDACS) have been used to evaluate patients with symptoms suggestive of acute myocardial infarct (AMI). This study assessed prognostic utility of cardiac risk stratification scores when augmented with a high-sensitivity cardiac troponin-I assay (hs-cTnI).
Methods |
This study enrolled 2,505 suspected AMI patients at 29 hospitals in the United States from April 2015 to April 2016. Blood samples were tested for hs-cTnI on the Atellica IM TnIH Assay (Siemens Healthineers). Patients were considered low risk for death/AMI with a TIMI score = 0, HEART ≤3, sEDACS ≤15, and hs-cTnI <45 ng/L (99th percentile) at time 0 and 2-3 hours.
Results |
There were 2,336 patients included after exclusions for ST-segment elevation myocardial infarction or incomplete data. At 30 days, 283 patients (12.1%) had been diagnosed with AMI, and there were 24 (1.0%) deaths and 213 (9.1%) revascularizations. Of 298 patients with death or AMI, 258 (86.6%) had elevated hs-cTnI. The HEART score and sEDACS identified 34.5% and 36.6% of patients as low risk, respectively. This was significantly more than the 12.1% identified by the TIMI score (P < .01).
Conclusions |
The TIMI, HEART, and sEDACS scores all identify low-risk patients when combined with hs-cTnI measurements. The HEART score and sEDACS identified more low-risk patients compared to the TIMI score. These patients could be considered for discharge from the emergency department without further testing.
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| ☆ | Funding: The study was funded by Siemens Healthineers (Erlangen, Germany). |
| ☆☆ | Disclosures: The authors had total control of the data for independent analyses, interpretation, and writing. Dr deFilippi has been a consultant for Abbott Diagnostics, FugiRebio Metabolomics, Ortho Diagnostics, Roche Diagnostics, and Siemens Healthineers; has received institutional research support from Inova; has received honoraria from WebMD; and receives royalties from UpToDate. Dr Peacock has received research grants from Abbott, Braincheck, Immunarray, Janssen, Ortho Clinical Diagnostics, Relypsa, and Roche; has served as a consultant to Abbott, Astra-Zeneca, Bayer, Beckman, Boehringer Ingelheim, Ischemia Care, Dx, Instrument Labs, Janssen, Nabriva, Ortho Clinical Diagnostics, Relypsa, Roche, Quidel, and Siemens, Healthineers; has provided expert testimony for Johnson and Johnson; and has stock/ownership interests in AseptiScope, Brainbox, Comprehensive Research Association, Emergencies in Medicine, and Ischemia DC. Dr Mahler receives research funding from Roche Diagnostics, Siemens Healthineers, Ortho Clinical Diagnostics, and Creavo Medical Technologies and has served on Advisory Boards for Roche Diagnostics; he is the Chief Medical Officer for Impathiq, Inq. Dr Nowak has been a consultant for Siemens Healthineers, Roche Diagnostics, Beckman Coulter, Ortho Diagnostics, and Abbott. Dr Christenson has received consultant fees from Siemens Healthineers, Roche Diagnostics, Quidel Diagnostics, Becton Dickinson, and Beckman Coulter. Dr Apple has served on the Board of Directors of HyTest Ltd; has served on Advisory Boards for Siemens Diagnostics and Instrumentation Laboratory; has been a consultant for LumiraDx; has received institutional research funding from Abbott Diagnostics, Abbott Point of Care, Roche Diagnostics, Siemens Healthineers, Quidel/Alere, Ortho-Clinical Diagnostics, ET Healthcare, and Beckman Coulter; and serves as Associate Editor of Clinical Chemistry. Dr McCord has been a consultant for Siemens Healthineers and Roche and has received research support from Siemens Healthineers, Abbott, Beckman, and Roche. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. |
Vol 227
P. 1-8 - septembre 2020 Retour au numéro
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