Accelerated Diagnostic Pathways for Myocardial Infarction Using a Siemens High-Sensitivity Cardiac Troponin I Assay

Hiroyuki Azuma; Masafumi Tada; Hideyuki Matano; Naoki Yamada; Hiroyasu Uzui; Koji Maeno; Yoshimitsu Shimada; Hiroyuki Yoshida; Hajime Murahashi; Masaki Ando; Kenta Hachiya; Shun Tanaka; Tomonori Hattori; Akira Kuriyama; Takeshi Fujisawa; Andrew R Chapman; Nicholas L Mills; Hiroyuki Hayashi; Norio Watanabe; Toshi A Furukawa

doi:10.1016/j.clinbiochem.2025.110897

Accelerated Diagnostic Pathways for Myocardial Infarction Using a Siemens High-Sensitivity Cardiac Troponin I Assay

Hiroyuki Azuma, Masafumi Tada^*, Hideyuki Matano, Naoki Yamada, Hiroyasu Uzui, Koji Maeno, Yoshimitsu Shimada, Hiroyuki Yoshida, Hajime Murahashi, Masaki Ando, Kenta Hachiya, Shun Tanaka, Tomonori Hattori, Akira Kuriyama, Takeshi Fujisawa, Andrew R Chapman, Nicholas L Mills, Hiroyuki Hayashi, Norio Watanabe, Toshi A Furukawa

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Few studies have comprehensively examined high-sensitivity cardiac troponin I (hs-cTnI) based diagnostic pathways for myocardial infarction (MI) in early presenters using a Siemens ADVIA Centaur hs-cTnI assay.

Methods: We conducted a prospective multicenter cohort study in Emergency Departments involving 414 patients suspected of MI within 6 hours of symptom onset. We evaluated three hs-cTnI-based pathways (High-STEACS, ESC 0/1-h, 0/2-h); and four pathways incorporating medical history and physical findings (ADAPT, EDACS, HEART, GRACE). We evaluated negative predictive value (NPV) and sensitivity as safety measures, and percentage ruled out as an efficiency measure for a primary outcome of type 1 myocardial infarction or cardiac death within 30 days.

Results: Median age was 72 years (interquartile range 58-82), and 30.4% (126/414) of patients were over 80. Females comprised 44.2% (183/414) of patients, 87.7% (363/414) had chest pain, and the primary outcome occurred in 9.2% (38/414). The High-STEACS pathway ruled out 62.0% of patients without missing a case of an MI. The ESC 0/1-h and 0/2-h pathways showed high NPV and sensitivities; however, they ruled out fewer patients (35.9% and 45.2%, respectively). The ADAPT, EDACS, and HEART pathways demonstrated high NPV and sensitivities but ruled out fewer patients (15-27%). The GRACE pathway missed 2 cases with primary clinical outcomes. Among patients over 80 without MI, initial hs-cTnI concentration was ≥3 ng/L in 99.1% and ≥5 ng/L in 84.1%.

Conclusions: The High-STEACS pathway was the most efficient among the hs-cTnI-based pathways while maintaining excellent safety performance in early presenters.

Original language	English
Journal	Clinical Biochemistry
Early online date	14 Feb 2025
DOIs	https://doi.org/10.1016/j.clinbiochem.2025.110897
Publication status	E-pub ahead of print - 14 Feb 2025

Keywords / Materials (for Non-textual outputs)

myocardial infarction
high sensitivity troponin
diagnostic pathway

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10.1016/j.clinbiochem.2025.110897Licence: Creative Commons: Attribution (CC-BY)

Accelerated Diagnostic Pathways_AZUMA_DOA12022025_VOR_CC-BYFinal published version, 815 KBLicence: Creative Commons: Attribution (CC-BY)

https://www.sciencedirect.com/science/article/pii/S0009912025000268Licence: Creative Commons: Attribution (CC-BY)

British Heart Foundation (BHF) Cardiovascular Biomarker Laboratory
Fujisawa, T. (Manager)
Deanery of Clinical Sciences
Facility/equipment: Facility

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Azuma, H., Tada, M., Matano, H., Yamada, N., Uzui, H., Maeno, K., Shimada, Y., Yoshida, H., Murahashi, H., Ando, M., Hachiya, K., Tanaka, S., Hattori, T., Kuriyama, A., Fujisawa, T., Chapman, A. R., Mills, N. L., Hayashi, H., Watanabe, N., & Furukawa, T. A. (2025). Accelerated Diagnostic Pathways for Myocardial Infarction Using a Siemens High-Sensitivity Cardiac Troponin I Assay. Clinical Biochemistry. Advance online publication. https://doi.org/10.1016/j.clinbiochem.2025.110897

@article{f03cb829975b43db800e15cc21231a6f,

title = "Accelerated Diagnostic Pathways for Myocardial Infarction Using a Siemens High-Sensitivity Cardiac Troponin I Assay",

abstract = "Background: Few studies have comprehensively examined high-sensitivity cardiac troponin I (hs-cTnI) based diagnostic pathways for myocardial infarction (MI) in early presenters using a Siemens ADVIA Centaur hs-cTnI assay.Methods: We conducted a prospective multicenter cohort study in Emergency Departments involving 414 patients suspected of MI within 6 hours of symptom onset. We evaluated three hs-cTnI-based pathways (High-STEACS, ESC 0/1-h, 0/2-h); and four pathways incorporating medical history and physical findings (ADAPT, EDACS, HEART, GRACE). We evaluated negative predictive value (NPV) and sensitivity as safety measures, and percentage ruled out as an efficiency measure for a primary outcome of type 1 myocardial infarction or cardiac death within 30 days.Results: Median age was 72 years (interquartile range 58-82), and 30.4% (126/414) of patients were over 80. Females comprised 44.2% (183/414) of patients, 87.7% (363/414) had chest pain, and the primary outcome occurred in 9.2% (38/414). The High-STEACS pathway ruled out 62.0% of patients without missing a case of an MI. The ESC 0/1-h and 0/2-h pathways showed high NPV and sensitivities; however, they ruled out fewer patients (35.9% and 45.2%, respectively). The ADAPT, EDACS, and HEART pathways demonstrated high NPV and sensitivities but ruled out fewer patients (15-27%). The GRACE pathway missed 2 cases with primary clinical outcomes. Among patients over 80 without MI, initial hs-cTnI concentration was ≥3 ng/L in 99.1% and ≥5 ng/L in 84.1%.Conclusions: The High-STEACS pathway was the most efficient among the hs-cTnI-based pathways while maintaining excellent safety performance in early presenters. ",

keywords = "myocardial infarction, high sensitivity troponin, diagnostic pathway",

author = "Hiroyuki Azuma and Masafumi Tada and Hideyuki Matano and Naoki Yamada and Hiroyasu Uzui and Koji Maeno and Yoshimitsu Shimada and Hiroyuki Yoshida and Hajime Murahashi and Masaki Ando and Kenta Hachiya and Shun Tanaka and Tomonori Hattori and Akira Kuriyama and Takeshi Fujisawa and Chapman, {Andrew R} and Mills, {Nicholas L} and Hiroyuki Hayashi and Norio Watanabe and Furukawa, {Toshi A}",

year = "2025",

month = feb,

day = "14",

doi = "10.1016/j.clinbiochem.2025.110897",

language = "English",

journal = "Clinical Biochemistry",

issn = "0009-9120",

publisher = "Elsevier Inc.",

}

Azuma, H, Tada, M, Matano, H, Yamada, N, Uzui, H, Maeno, K, Shimada, Y, Yoshida, H, Murahashi, H, Ando, M, Hachiya, K, Tanaka, S, Hattori, T, Kuriyama, A, Fujisawa, T, Chapman, AR, Mills, NL, Hayashi, H, Watanabe, N & Furukawa, TA 2025, 'Accelerated Diagnostic Pathways for Myocardial Infarction Using a Siemens High-Sensitivity Cardiac Troponin I Assay', Clinical Biochemistry. https://doi.org/10.1016/j.clinbiochem.2025.110897

TY - JOUR

T1 - Accelerated Diagnostic Pathways for Myocardial Infarction Using a Siemens High-Sensitivity Cardiac Troponin I Assay

AU - Azuma, Hiroyuki

AU - Tada, Masafumi

AU - Matano, Hideyuki

AU - Yamada, Naoki

AU - Uzui, Hiroyasu

AU - Maeno, Koji

AU - Shimada, Yoshimitsu

AU - Yoshida, Hiroyuki

AU - Murahashi, Hajime

AU - Ando, Masaki

AU - Hachiya, Kenta

AU - Tanaka, Shun

AU - Hattori, Tomonori

AU - Kuriyama, Akira

AU - Fujisawa, Takeshi

AU - Chapman, Andrew R

AU - Mills, Nicholas L

AU - Hayashi, Hiroyuki

AU - Watanabe, Norio

AU - Furukawa, Toshi A

PY - 2025/2/14

Y1 - 2025/2/14

N2 - Background: Few studies have comprehensively examined high-sensitivity cardiac troponin I (hs-cTnI) based diagnostic pathways for myocardial infarction (MI) in early presenters using a Siemens ADVIA Centaur hs-cTnI assay.Methods: We conducted a prospective multicenter cohort study in Emergency Departments involving 414 patients suspected of MI within 6 hours of symptom onset. We evaluated three hs-cTnI-based pathways (High-STEACS, ESC 0/1-h, 0/2-h); and four pathways incorporating medical history and physical findings (ADAPT, EDACS, HEART, GRACE). We evaluated negative predictive value (NPV) and sensitivity as safety measures, and percentage ruled out as an efficiency measure for a primary outcome of type 1 myocardial infarction or cardiac death within 30 days.Results: Median age was 72 years (interquartile range 58-82), and 30.4% (126/414) of patients were over 80. Females comprised 44.2% (183/414) of patients, 87.7% (363/414) had chest pain, and the primary outcome occurred in 9.2% (38/414). The High-STEACS pathway ruled out 62.0% of patients without missing a case of an MI. The ESC 0/1-h and 0/2-h pathways showed high NPV and sensitivities; however, they ruled out fewer patients (35.9% and 45.2%, respectively). The ADAPT, EDACS, and HEART pathways demonstrated high NPV and sensitivities but ruled out fewer patients (15-27%). The GRACE pathway missed 2 cases with primary clinical outcomes. Among patients over 80 without MI, initial hs-cTnI concentration was ≥3 ng/L in 99.1% and ≥5 ng/L in 84.1%.Conclusions: The High-STEACS pathway was the most efficient among the hs-cTnI-based pathways while maintaining excellent safety performance in early presenters.

AB - Background: Few studies have comprehensively examined high-sensitivity cardiac troponin I (hs-cTnI) based diagnostic pathways for myocardial infarction (MI) in early presenters using a Siemens ADVIA Centaur hs-cTnI assay.Methods: We conducted a prospective multicenter cohort study in Emergency Departments involving 414 patients suspected of MI within 6 hours of symptom onset. We evaluated three hs-cTnI-based pathways (High-STEACS, ESC 0/1-h, 0/2-h); and four pathways incorporating medical history and physical findings (ADAPT, EDACS, HEART, GRACE). We evaluated negative predictive value (NPV) and sensitivity as safety measures, and percentage ruled out as an efficiency measure for a primary outcome of type 1 myocardial infarction or cardiac death within 30 days.Results: Median age was 72 years (interquartile range 58-82), and 30.4% (126/414) of patients were over 80. Females comprised 44.2% (183/414) of patients, 87.7% (363/414) had chest pain, and the primary outcome occurred in 9.2% (38/414). The High-STEACS pathway ruled out 62.0% of patients without missing a case of an MI. The ESC 0/1-h and 0/2-h pathways showed high NPV and sensitivities; however, they ruled out fewer patients (35.9% and 45.2%, respectively). The ADAPT, EDACS, and HEART pathways demonstrated high NPV and sensitivities but ruled out fewer patients (15-27%). The GRACE pathway missed 2 cases with primary clinical outcomes. Among patients over 80 without MI, initial hs-cTnI concentration was ≥3 ng/L in 99.1% and ≥5 ng/L in 84.1%.Conclusions: The High-STEACS pathway was the most efficient among the hs-cTnI-based pathways while maintaining excellent safety performance in early presenters.

KW - myocardial infarction

KW - high sensitivity troponin

KW - diagnostic pathway

U2 - 10.1016/j.clinbiochem.2025.110897

DO - 10.1016/j.clinbiochem.2025.110897

M3 - Article

SN - 0009-9120

JO - Clinical Biochemistry

JF - Clinical Biochemistry

ER -

Accelerated Diagnostic Pathways for Myocardial Infarction Using a Siemens High-Sensitivity Cardiac Troponin I Assay

Abstract

Keywords / Materials (for Non-textual outputs)

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Equipment

British Heart Foundation (BHF) Cardiovascular Biomarker Laboratory

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