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High sensitive cardiac troponin i at admission and 30 minutes later to rule-in or rule-out acute myocardial infarction - Preliminary results from the RACING-MI trial

Session Cardiac troponins and other biomarkers in acute coronary syndromes

Speaker Camilla Bang

Event : ESC Congress 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Biomarkers
  • Session type : Rapid Fire Abstracts

Authors : C Bang (Randers,DK), C Hansen (Randers,DK), K Glerup Lauridsen (Aarhus,DK), C Alcaraz Frederiksen (Aarhus,DK), M Schmidt (Herning,DK), T Jensen (Randers,DK), N Hornung (Herning,DK), B Loefgren (Aarhus,DK)

C Bang1 , C Hansen1 , K Glerup Lauridsen2 , C Alcaraz Frederiksen3 , M Schmidt4 , T Jensen5 , N Hornung6 , B Loefgren2 , 1Randers Regional Hospital, Clinical Research Unit - Randers - Denmark , 2Aarhus University Hospital, Research Center for Emergency Medicine - Aarhus - Denmark , 3Aarhus University Hospital, Department of Cardiology - Aarhus - Denmark , 4Regional Hospital West Jutland, Department of Cardiology - Herning - Denmark , 5Randers Regional Hospital, Department of Internal Medicine - Randers - Denmark , 6Region Hospital Herning, Department of Clinical Biochemistry - Herning - Denmark ,


Introduction: Current ESC guidelines have introduced a 0h/1h algorithm for accelerated rule-in or rule-out of acute myocardial infarction (MI) when using assay specific high-sensitive cardiac troponin I (hs-cTnI). Several studies have investigated the diagnostic performance and safety of this approach using different hs-cTnI assays. However, little is known of the diagnostic performance of a 0h/30min algorithm. 

Purpose: To evaluate the diagnostic accuracy of early rule-in or rule-out of MI after 30 minutes by applying assay specific hs-cTnI cut-off values from a recently validated 0h/1h algorithm.

Methods: We prospectively enrolled chest pain patients suggestive of MI admitted to the Emergency Department. Patients underwent serial hs-cTnI measurements at admission (0 hour) and after 3 hours according to clinical practice. In addition, hs-cTnI measurements were performed after 30 minutes. The assay specific cut-off values from the 0h/1h algorithm were applied to the 30 minute cohort (figure 1). Final diagnosis was adjudicated independently by two physicians.

Results: In total, 943 patients were included. MI was the final diagnosis in 67 (7.1%)  patients. Overall, absolute hs-cTnI values after 30 minutes were significantly higher in the MI group than in the non-MI group (19.2 (Q1:Q3) 2.7-75.3) ng/L versus 0.1 (0.2–0.7) ng/L, p<0.001). When applying the assay-specific hs-cTnI cut-off valuesfor the 0h/1h algorithmto the 30 minute patient cohort, 52.4% of patients were classified as rule-out with a negative predictive value of 100% (95% CI: 99.2-100). In total, 8.5% were classified as rule-in with a positive predictive value of 83.8% (95% CI: 74.2-90.3). Sensitivity was 100% (95% CI: 94.6-100) and specificity was 97.4% (95% CI: 95.7-98.6). Overall, 39.1% were assigned to the observational zone with a 3.5% prevalence of MI. 

Conclusions: The use of assay specific hs-cTnI measurement at admission (0h) and 30 min later can be used to safely rule-out MI. This indicates that it might be safe to develop a 0h/30min algorithm and hereby reduce time to diagnosis even further. NCT03634384.

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