The American journal of emergency medicine · 2026
Is an ED discharge safe after a single cardiac troponin: Analysis of the FAST-TRAC study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Peacock W Frank, Mueller Christian, Anker Stefan D, Apple Fred S, Christenson Robert H, Daniels Lori B, Diercks Deborah B, Di Somma Salvatore, Filippatos Gerasimos, Headden Gary, Hiestand Brian, Hollander Judd E, Kosowsky Joshua M, Vilke Gary M, Than Martin, Budd Jeffrey
Аннотация
BACKGROUND: Serial Highly Sensitive Cardiac Troponin I (hscTnI) measures are commonly performed in patients presenting to the ED to exclude suspected Acute Myocardial Infarction (AMI). The previously published FAST-TRAC study prospectively enrolled patients presenting to the ED within 6 h of onset of symptoms consistent with suspected AMI. Our purpose was to evaluate the performance of a single hscTnI measurement, termed "one-and-done" using this cohort.
METHODS: In emergency department suspected acute coronary syndrome patients, serial blood samples were prospectively obtained for blinded hscTnI measurement (Access TnI, Beckman Coulter, Brea, CA) at 1, 2, 3-4, and 6-12 h after presentation. Patients were followed for 30-day Major Adverse Cardiac Events (MACE) determined by adjudicators blinded to hsTnI results.
RESULTS: Of 1520 patients enrolled, 113 (7.4%) were adjudicated as AMI, with 59% male, median (IQR: Interquartile Rank) age of 57 years (48-67), 66% White, 28% African American, and 3% Asian American. The overall median (IQR) time to first hscTnI draw after symptom onset was 3.67 (2.50-5.09) hours. Serial hscTnI and one-and-done strategies had comparable C-statistics for AMI; 0.95 (0.93-0.98) vs 0.93 (0.91-0.96), respectively. In no circumstance did the 99th percentile cutpoint meet an adequate rule-out AMI sensitivity of 99%. Serial measures using either the 10% or 20% Coefficient of Variation (CV) Level of Quantification (LOQ) cutpoint had the same sensitivity of 99.1%, but the 10% CV LOQ had higher specificity, 61.7%, (95% CI = 59.1-64.2). For a "one-and-done" strategy, only the 20% CV LOQ, with a sensitivity of 99.1 (95.2-99.8), met the 99% sensitivity goal. Using the 20% CV LOQ, a "one-and-done" strategy would have immediately ruled out 39% (n = 550) of patients for AMI, with only 61% (n = 857) requiring additional serial hscTnI testing.
CONCLUSIONS: A "one-and-done" strategy using a hscTnI <20% CV LOQ provides the most efficient AMI rule-out performance.
REGISTRATION: NCT00880802.
METHODS: In emergency department suspected acute coronary syndrome patients, serial blood samples were prospectively obtained for blinded hscTnI measurement (Access TnI, Beckman Coulter, Brea, CA) at 1, 2, 3-4, and 6-12 h after presentation. Patients were followed for 30-day Major Adverse Cardiac Events (MACE) determined by adjudicators blinded to hsTnI results.
RESULTS: Of 1520 patients enrolled, 113 (7.4%) were adjudicated as AMI, with 59% male, median (IQR: Interquartile Rank) age of 57 years (48-67), 66% White, 28% African American, and 3% Asian American. The overall median (IQR) time to first hscTnI draw after symptom onset was 3.67 (2.50-5.09) hours. Serial hscTnI and one-and-done strategies had comparable C-statistics for AMI; 0.95 (0.93-0.98) vs 0.93 (0.91-0.96), respectively. In no circumstance did the 99th percentile cutpoint meet an adequate rule-out AMI sensitivity of 99%. Serial measures using either the 10% or 20% Coefficient of Variation (CV) Level of Quantification (LOQ) cutpoint had the same sensitivity of 99.1%, but the 10% CV LOQ had higher specificity, 61.7%, (95% CI = 59.1-64.2). For a "one-and-done" strategy, only the 20% CV LOQ, with a sensitivity of 99.1 (95.2-99.8), met the 99% sensitivity goal. Using the 20% CV LOQ, a "one-and-done" strategy would have immediately ruled out 39% (n = 550) of patients for AMI, with only 61% (n = 857) requiring additional serial hscTnI testing.
CONCLUSIONS: A "one-and-done" strategy using a hscTnI <20% CV LOQ provides the most efficient AMI rule-out performance.
REGISTRATION: NCT00880802.