Objectives The HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve > 99% sensitivity for major adverse cardiac events (MACE) at 30 days and early discharge rates > 20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. Design & methods A secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. Each patient was risk stratified by the cTn-HEART Pathway (Siemens TnI-Ultra at 0- and 3-h) and a hs-cTn-HEART Pathway using hs-cTnI (Abbott) or hs-cTnT (Roche) at 3-h. The early discharge rate, sensitivity, specificity, and negative predictive value (NPV) for MACE (death, myocardial infarction, or coronary revascularization) at 30 days were calculated. Results hs-cTnI measures were available on 133 patients. MACE occurred in 11/133 (8%) of these patients. Test characteristics for the HEART Pathway using serial cTnI vs 3 hour hs-cTnI were the same: sensitivity (100%, 95%CI: 72–100%), specificity (49%, 95%CI: 40–58%), NPV (100%, 95%CI: 94–100%), and early discharge rate (45%, 95%CI: 37–54%). The HEART Pathway using hs-cTnT missed one MACE event (myocardial infarction): sensitivity (91%, 95%CI: 59–100%), specificity (48%, 95%CI: 39–57%), NPV (98%, 95%CI: 91–100%), and early discharge rate (45%, 95%CI: 37–54%). Conclusions There was no difference in the test characteristics of the HEART Pathway whether using cTnI or hs-cTnI, with both achieving 100% sensitivity and NPV. Use of hs-cTnT with the HEART Pathway was associated with one missed MACE.
Bibliographical noteFunding Information:
This study was funded by the AHA Clinical Research Program (12CRP12000001 and 13CRP17090055) and in part by the Minneapolis Medical Research Foundation. Supplies provided by Abbott Laboratories and Roche Diagnostics. Dr. Mahler receives research funding from the AAMC/Donaghue Foundation, Duke Endowment, Abbott Point of Care, and NHLBI (1 R01 HL118263-01, L30 HL120008). Use of Research Electronic Data Capture was supported by the Wake Forest Translational Science Institute via a grant from National Center for Catalysis Research (M01 RR007122).
- Acute coronary syndrome
- Chest pain
- HEART Pathway