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Friday, March 19, 2021

High Sensitivity Cardiac Troponin T

REBEL EM - March 19, 2021 - By Benjamin M. Gerretsen,
Paper: Allen et al. Diagnostic Performance of High Sensitivity Cardiac Troponin T Strategies and Clinical Variables in a Multisite United States Cohort. Circulation 2021. PMID 33474976
“Clinical Questions: 
  • What is the diagnostic performance (safety and efficacy) of the Roche hs-cTnT assay for the detection of 30-day MACE (plus the composite of cardiac death or MI) at 30 days using an initial hs-cTnT below the limit of quantification (LOQ) and a 0/1-h algorithm?
  • Same question as above both with and without the inclusion of ECG interpretation and HEART score?
Author Conclusion: “In a prospective multisite US cohort, an initial hs-cTnT <LOQ combined with a low-risk HEART score was 99% NPV for 30-day MACE. The 0/1-h hs-cTnT algorithm did not achieve a NPV >99% for 30-day MACE when used alone or with a HEART score.”
Clinical Take Home Point: Addition of the HEART score to an initial hs-TnT below the limit of quantification improves sensitivity and NPV for cardiac events increasing patient safety, but this strategy does rule-out fewer patients.”