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Licensed Unlicensed Requires Authentication Published by De Gruyter December 23, 2020

Evaluation of the 0 h/1 h high-sensitivity cardiac troponin T algorithm in diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) in Han population

  • Chen Dongxu , Zhou Yannan , Yang Yilin , Yao Chenling EMAIL logo , Gu Guorong EMAIL logo , Wang Kouqiong , Guo Wei , Shi Dongwei , Song Zhenju and Tong Chaoyang

Abstract

Objectives

A rapid 0 h/1 h algorithm using high-sensitivity cardiac troponin T (hs-cTnT) for rule-out and rule-in of non-ST-segment elevation myocardial infarction (NSTEMI) is recommended by the European Society of Cardiology. We aim to prospectively evaluate the diagnostic performance of the algorithm in Chinese Han patients with suspected NSTEMI.

Methods

In this prospective diagnostic cohort study, 577 patients presenting to the emergency department with suspected NSTEMI and recent (<12 h) onset of symptoms were enrolled. The levels of serum hs-cTnT were measured on admission, 1 h later and 4–14 h later. All patients underwent the initial clinical assessment and were triaged into three groups (rule-out, rule-in and observe) according to the 0 h/1 h algorithm. The major cardiovascular events (MACE) were evaluated at the 7-day and 30-day follow-ups.

Results

Among 577 enrolled patients, NSTEMI was the final diagnosis for 106 (18.4%) patients. Based on the hs-cTnT 0 h/1 h algorithm, 148 patients (25.6%) were classified as rule-out, 278 patients (48.2%) as rule-in and 151 patients (26.2%) were assigned to the observe group. The rule-out approach resulted in a sensitivity of 100% and negative predictive value of 100%. The rule-in approach resulted in a specificity of 62.9% [95% CI (58.5–67.2%)] and positive predictive value of 37.1% [95%CI (31.3–42.8%)]. No MACE was observed in the rule-out group within 30-day follow-up.

Conclusions

The hs-cTnT 0 h/1 h algorithm is a safe tool for early rule-out of NSTEMI, while probably not an effective strategy for accurate rule-in of NSTEMI in Chinese Han population.


Corresponding authors: Yao Chenling and Gu Guorong, Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, P.R. China, E-mail: ,
Chen Dongxu, Zhou Yannan and Yang Yilin contributed equally to this work and should be considered co-first authors.

Funding source: Key Project of Shanghai Municipal Health Bureau

Award Identifier / Grant number: 2016ZB0202

Funding source: The Scientific Research Project of Shanghai Municipal Health Bureau

Award Identifier / Grant number: 201940163

Funding source: Shanghai Shenkang Hospital Development Center

Award Identifier / Grant number: SHDC12019615

Acknowledgments

The authors thank the patients who participated in this research, the emergency department staff and the laboratory technicians of all participating sites for their valuable effort.

  1. Research funding: This study was supported by Key Project of Shanghai Municipal Health Bureau (2016ZB0202), the Scientific Research Project of Shanghai Municipal Health Bureau (201940163) and Clinical Science and Technology Innovation Project of Shanghai Shenkang Hospital Development Center (SHDC12019615).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: The study was carried out according to the principles of the Declaration of Helsinki and approved by the local Ethics Committee.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-0367).


Received: 2020-03-22
Accepted: 2020-10-12
Published Online: 2020-12-23
Published in Print: 2021-03-26

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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