Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Simon A. Mahler; Jason P. Stopyra; Fred S. Apple; Robert F. Riley; Gregory B. Russell; Brian C. Hiestand; James W. Hoekstra; Cedric W. Lefebvre; Bret A. Nicks; David M. Cline; Kim L. Askew; David M. Herrington; Gregory L. Burke; Chadwick D. Miller

doi:10.1016/j.clinbiochem.2017.01.003

Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Simon A. Mahler, Jason P. Stopyra, Fred S. Apple, Robert F. Riley, Gregory B. Russell, Brian C. Hiestand, James W. Hoekstra, Cedric W. Lefebvre, Bret A. Nicks, David M. Cline, Kim L. Askew, David M. Herrington, Gregory L. Burke, Chadwick D. Miller

Research output: Contribution to journal › Article › peer-review

23 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	401-407
Number of pages	7
Journal	Clinical Biochemistry
Volume	50
Issue number	7-8
DOIs	https://doi.org/10.1016/j.clinbiochem.2017.01.003
State	Published - May 2017
Externally published	Yes

Bibliographical note

Funding 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).

Publisher Copyright:
© 2017 The Canadian Society of Clinical Chemists

Keywords

Acute coronary syndrome
Chest pain
HEART Pathway
Troponin

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.clinbiochem.2017.01.003

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Mahler, S. A., Stopyra, J. P., Apple, F. S., Riley, R. F., Russell, G. B., Hiestand, B. C., Hoekstra, J. W., Lefebvre, C. W., Nicks, B. A., Cline, D. M., Askew, K. L., Herrington, D. M., Burke, G. L., & Miller, C. D. (2017). Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis. Clinical Biochemistry, 50(7-8), 401-407. https://doi.org/10.1016/j.clinbiochem.2017.01.003

Mahler, SA, Stopyra, JP, Apple, FS, Riley, RF, Russell, GB, Hiestand, BC, Hoekstra, JW, Lefebvre, CW, Nicks, BA, Cline, DM, Askew, KL, Herrington, DM, Burke, GL & Miller, CD 2017, 'Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis', Clinical Biochemistry, vol. 50, no. 7-8, pp. 401-407. https://doi.org/10.1016/j.clinbiochem.2017.01.003

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title = "Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis",

abstract = "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.",

keywords = "Acute coronary syndrome, Chest pain, HEART Pathway, Troponin",

author = "Mahler, {Simon A.} and Stopyra, {Jason P.} and Apple, {Fred S.} and Riley, {Robert F.} and Russell, {Gregory B.} and Hiestand, {Brian C.} and Hoekstra, {James W.} and Lefebvre, {Cedric W.} and Nicks, {Bret A.} and Cline, {David M.} and Askew, {Kim L.} and Herrington, {David M.} and Burke, {Gregory L.} and Miller, {Chadwick D.}",

note = "Funding 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). Publisher Copyright: {\textcopyright} 2017 The Canadian Society of Clinical Chemists",

year = "2017",

month = may,

doi = "10.1016/j.clinbiochem.2017.01.003",

language = "English (US)",

volume = "50",

pages = "401--407",

journal = "Clinical Biochemistry",

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TY - JOUR

T1 - Use of the HEART Pathway with high sensitivity cardiac troponins

T2 - A secondary analysis

AU - Mahler, Simon A.

AU - Stopyra, Jason P.

AU - Apple, Fred S.

AU - Riley, Robert F.

AU - Russell, Gregory B.

AU - Hiestand, Brian C.

AU - Hoekstra, James W.

AU - Lefebvre, Cedric W.

AU - Nicks, Bret A.

AU - Cline, David M.

AU - Askew, Kim L.

AU - Herrington, David M.

AU - Burke, Gregory L.

AU - Miller, Chadwick D.

N1 - Funding 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). Publisher Copyright: © 2017 The Canadian Society of Clinical Chemists

PY - 2017/5

Y1 - 2017/5

N2 - 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.

AB - 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.

KW - Acute coronary syndrome

KW - Chest pain

KW - HEART Pathway

KW - Troponin

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Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis

Abstract

Bibliographical note

Keywords

UN SDGs

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