RT Journal Article
SR Electronic
T1 Validation of NICE diagnostic guidance for rule out of myocardial infarction using high-sensitivity troponin tests
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1279
OP 1286
DO 10.1136/heartjnl-2016-309270
VO 102
IS 16
A1 W A Parsonage
A1 C Mueller
A1 J H Greenslade
A1 K Wildi
A1 J Pickering
A1 M Than
A1 S Aldous
A1 J Boeddinghaus
A1 C J Hammett
A1 T Hawkins
A1 T Nestelberger
A1 T Reichlin
A1 S Reidt
A1 M Rubin Gimenez
A1 J R Tate
A1 R Twerenbold
A1 J P Ungerer
A1 L Cullen
YR 2016
UL http://heart.bmj.com/content/102/16/1279.abstract
AB Objective To validate the National Institute for Health and Care Excellence (NICE) recommended algorithms for high-sensitivity troponin (hsTn) assays in adults presenting with chest pain.Methods International post hoc analysis of three prospective, observational studies from tertiary hospital emergency departments. The primary endpoint was cardiac death or acute myocardial infarction (AMI) within 24 hours of presentation, and the secondary endpoint was major adverse cardiac events (MACE) at 30 days.Results 15% of patients were diagnosed with non-ST elevation myocardial infarction (MI) on admission. The hsTnI algorithm classified 2506/3128 (80.1%) of patients as ‘ruled out’ with 50 (2.0%) missed MI. 943/3128 (30.1%) of patients had a troponin I level below the limit of detection on admission with 2 (0.2%) missed MI. For the hsTnT algorithm, 1794/3374 (53.1%) of patients were ‘ruled out’ with 7 (0.4%) missed MI. 490/3374 (14.5%) of patients had a troponin T below the limit of blank on admission with no MI. MACE at 30 days occurred in 10.7% and 8.5% of patients ‘ruled out’ defined by the hsTnI and hsTnT algorithms, respectively.Conclusions The NICE algorithms could identify patients with low probability of AMI within 2 hours; however, neither strategy performed as predicted by the NICE diagnostic guidance model. Additionally, the rate of MACE at 30 days was sufficiently high that the algorithms should only be used as one component of a more extensive model of risk stratification.Trial registration number ACTRN12611001069943, NCT00470587; post-results.