The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: an observational study

Onlak Ruangsomboon; Pattaraporn Mekavuthikul; Tipa Chakorn; Apichaya Monsomboon; Nattakarn Prapruetkit; Usapan Surabenjawong; Chok Limsuwat; Sattha Riyapan; Wansiri Chaisirin

doi:10.1186/s12245-018-0204-9

The feasibility of the 1-h high-sensitivity cardiac troponin T algorithm to rule-in and rule-out acute myocardial infarction in Thai emergency patients: an observational study

Int J Emerg Med. 2018 Oct 22;11(1):43. doi: 10.1186/s12245-018-0204-9.

Authors

Onlak Ruangsomboon¹, Pattaraporn Mekavuthikul², Tipa Chakorn², Apichaya Monsomboon², Nattakarn Prapruetkit², Usapan Surabenjawong², Chok Limsuwat², Sattha Riyapan², Wansiri Chaisirin²

Affiliations

¹ Department of Emergency Medicine, Siriraj Hospital Mahidol University, 2 Wangland Rd. Bangkoknoi, Bangkok, 10700, Thailand. doctor.mo@yahoo.com.
² Department of Emergency Medicine, Siriraj Hospital Mahidol University, 2 Wangland Rd. Bangkoknoi, Bangkok, 10700, Thailand.

Abstract

Background: The 3-h high-sensitivity cardiac troponin T (hs-cTnT) algorithm is the most commonly used scheme to diagnose acute myocardial infarction. The 1-h hs-cTnT algorithm has recently been approved by the European Society of Cardiology as an alternative algorithm for earlier diagnosis. If the hs-cTnT test cannot discriminate the diagnosis of the patient at 1 h, the patient is defined as observational group. Their test must be repeated at 3 h. A high prevalence of this group may indicate a low clinical utility of the 1-h hs-cTnT algorithm. This study was aimed to estimate the proportion of the observational group in Thai emergency department (ED) patients and also the time to rule-in/out between both the algorithms.

Methods: A historical control study was conducted in patients with chest pain for 1-12 h at the ED of Siriraj Hospital, Bangkok, Thailand. The study compared two groups: one prospective group of all patients evaluated with the 1-h hs-cTnT algorithm between June and September 2017 and one historical control group evaluated with the 3-h hs-cTnT algorithm between January and March 2017.

Results: A total of 130 patients were included (3-h hs-cTnT algorithm group n = 65 and 1-h hs-cTnT algorithm group n = 65). Twelve patients [18.5% (95% CI 10.0-30.1)] were categorized as observational group in the 1-h hs-cTnT algorithm group. The mean rule-in/out times in the 3-h hs-cTnT algorithm and 1-h hs-cTnT algorithm groups were 238 min (SD 63.3) and 134 min (SD 68.5), respectively (both p < 0.001). The time to disposition was also shortened in the 1-h hs-cTnT algorithm group (p < 0.001). Multivariable regression analysis performed to identify and adjust for confounders among patient characteristics revealed no significant confounders.

Conclusions: The use of the 1-h hs-cTnT algorithm in the ED resulted in an acceptable proportion in the observational group and a decreased time to rule-in/out compared with the 3-h hs-cTnT algorithm.

Keywords: 1-h hs-cTnT algorithm; Acute myocardial infarction; Chest pain; Emergency department; High-sensitivity cardiac troponin T.