Diagnostic accuracy of TRUST ADP and detection limit cut-offs of hs-cTnT for the prediction of fatal/non-fatal AMI and MACE in patients with a non-ischaemic ECG
| Number of events (%) | Sensitivity (95% CI) | NPV (95% CI) | Specificity (95% CI) | PPV (95% CI) | +LR (95% CI) | −LR (95% CI) | Percentage of eligible for early discharge | |
|---|---|---|---|---|---|---|---|---|
| Primary outcome fatal/non-fatal AMI | ||||||||
| TRUST ADP Low risk | 1/382 (0.3) | 98.8 (92.4 to 99.9) | 99.7 (98.4 to 100) | 43.3 (42.7 to 43.4) | 13.7 (12.8 to 13.8) | 1.741 (1.613 to 1.766) | 0.029 (0.002 to 0.178) | 39.8 |
| hs-cTnT <5 ng/L | 0/270 (0.0) | 100 (94.3 to 100) | 100 (98.3 to 100) | 32.0 (31.5 to 32.0) | 12.0 (11.3 to 12.0) | 1.470 (1.375 to 1.470) | 0.000 (0.000 to 0.183) | 29.3 |
| hs-cTnT <3 ng/L | 0/73 (0.0) | 100 (94.4 to 100) | 100 (94.0 to 100) | 8.6 (8.1 to 8.6) | 9.2 (8.7 to 9.2) | 1.095 (1.028 to 1.095) | 0.000 (0.000 to 0.685) | 7.9 |
| Secondary outcome MACE | ||||||||
| TRUST ADP Low risk | 1/382 (0.3) | 99.0 (93.7 to 99.9) | 99.7 (98.4 to 100) | 44.1 (43.6 to 44.3) | 16.6 (15.7 to 16.8) | 1.772 (1.659 to 1.793) | 0.023 (0.001 to 0.145) | 39.8 |
| hs-cTnT <5 ng/L | 3/270 (1.1) | 96.8 (90.6 to 99.2) | 98.9 (96.7 to 99.7) | 32.3 (31.6 to 32.6) | 14.1 (13.2 to 14.5) | 1.430 (1.323 to 1.470) | 0.098 (0.025 to 0.299) | 29.3 |
| hs-cTnT <3 ng/L | 1/73 (1.4) | 98.9 (93.8 to 99.9) | 98.6 (91.9 to 99.9) | 8.7 (8.1 to 8.8) | 11.1 (10.5 to 11.2) | 1.084 (1.020 to 1.096) | 0.121 (0.006 to 0.769) | 7.9 |
ADP, accelerated diagnostic protocol; AMI, acute myocardial infarction; hs-cTnT, high-sensitivity troponin T; +LR, positive likelihood ratio; −LR, negative likelihood ratio; MACE, major adverse cardiac event; NPV, negative predictive value; PPV, positive predictive value; TRUST, Triage Rule-out Using high-Sensitivity Troponin.