High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

High-STEACS investigators; Anoop S V Shah; Atul Anand; Yader Sandoval; Kuan Ken Lee; Stephen W Smith; Philip D Adamson; Andrew R. Chapman; Timothy Langdon; Dennis Sandeman; Amar Vaswani; Fiona E. Strachan; Amy Ferry; Alexandra G Stirzaker; Alan Reid; Alasdair J Gray; Paul O Collinson; David A McAllister; Fred S Apple; David E Newby; Nicholas L Mills

doi:10.1016/S0140-6736(15)00391-8

High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

High-STEACS investigators, Anoop S V Shah, Atul Anand, Yader Sandoval, Kuan Ken Lee, Stephen W Smith, Philip D Adamson, Andrew R. Chapman, Timothy Langdon, Dennis Sandeman, Amar Vaswani, Fiona E. Strachan, Amy Ferry, Alexandra G Stirzaker, Alan Reid, Alasdair J Gray, Paul O Collinson, David A McAllister, Fred S Apple, David E NewbyNicholas L Mills

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Abstract / Description of output

Background: Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits.

Methods: We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123).

Findings: 782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3-99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8-99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21-0·80; p<0·0001).

Interpretation: Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital. Implementation of this approach could substantially reduce hospital admissions and have major benefits for both patients and health-care providers.

Funding: British Heart Foundation and Chief Scientist Office (Scotland).

Original language	English
Pages (from-to)	2481-2488
Number of pages	8
Journal	The Lancet
Volume	386
Issue number	10012
Early online date	7 Oct 2015
DOIs	https://doi.org/10.1016/S0140-6736(15)00391-8
Publication status	Published - 19 Dec 2015

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High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome
Copyright © 2015 Shah et al. Open Access article distributed under the terms of CC BY-NC-ND.
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Nicholas Mills
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- Deanery of Clinical Sciences - Personal Chair of Cardiology
- Centre for Cardiovascular Science
- Edinburgh Imaging
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David Newby
- d.e.newbyed.acuk
- Deanery of Clinical Sciences - BHF Duke of Edinburgh Chair of Cardiology
- Centre for Cardiovascular Science
- Edinburgh Imaging
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High-STEACS investigators, Shah, A. S. V., Anand, A., Sandoval, Y., Lee, K. K., Smith, S. W., Adamson, P. D., Chapman, A. R., Langdon, T., Sandeman, D., Vaswani, A., Strachan, F. E., Ferry, A., Stirzaker, A. G., Reid, A., Gray, A. J., Collinson, P. O., McAllister, D. A., Apple, F. S., ... Mills, N. L. (2015). High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. The Lancet, 386(10012), 2481-2488. https://doi.org/10.1016/S0140-6736(15)00391-8

@article{9493e436eba846db91c271d2c6ddbb8d,

title = "High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study",

abstract = "Background: Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits.Methods: We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123).Findings: 782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3-99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8-99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21-0·80; p<0·0001).Interpretation: Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital. Implementation of this approach could substantially reduce hospital admissions and have major benefits for both patients and health-care providers.Funding: British Heart Foundation and Chief Scientist Office (Scotland).",

author = "{High-STEACS investigators} and Shah, {Anoop S V} and Atul Anand and Yader Sandoval and Lee, {Kuan Ken} and Smith, {Stephen W} and Adamson, {Philip D} and Chapman, {Andrew R.} and Timothy Langdon and Dennis Sandeman and Amar Vaswani and Strachan, {Fiona E.} and Amy Ferry and Stirzaker, {Alexandra G} and Alan Reid and Gray, {Alasdair J} and Collinson, {Paul O} and McAllister, {David A} and Apple, {Fred S} and Newby, {David E} and Mills, {Nicholas L}",

note = "Date of Acceptance: 15/09/2015",

year = "2015",

month = dec,

day = "19",

doi = "10.1016/S0140-6736(15)00391-8",

language = "English",

volume = "386",

pages = "2481--2488",

journal = "The Lancet",

issn = "0140-6736",

publisher = "Elsevier",

number = "10012",

}

High-STEACS investigators, Shah, ASV, Anand, A, Sandoval, Y, Lee, KK, Smith, SW, Adamson, PD, Chapman, AR, Langdon, T, Sandeman, D, Vaswani, A, Strachan, FE, Ferry, A, Stirzaker, AG, Reid, A, Gray, AJ, Collinson, PO, McAllister, DA, Apple, FS, Newby, DE & Mills, NL 2015, 'High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study', The Lancet, vol. 386, no. 10012, pp. 2481-2488. https://doi.org/10.1016/S0140-6736(15)00391-8

TY - JOUR

T1 - High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

AU - High-STEACS investigators

AU - Shah, Anoop S V

AU - Anand, Atul

AU - Sandoval, Yader

AU - Lee, Kuan Ken

AU - Smith, Stephen W

AU - Adamson, Philip D

AU - Chapman, Andrew R.

AU - Langdon, Timothy

AU - Sandeman, Dennis

AU - Vaswani, Amar

AU - Strachan, Fiona E.

AU - Ferry, Amy

AU - Stirzaker, Alexandra G

AU - Reid, Alan

AU - Gray, Alasdair J

AU - Collinson, Paul O

AU - McAllister, David A

AU - Apple, Fred S

AU - Newby, David E

AU - Mills, Nicholas L

N1 - Date of Acceptance: 15/09/2015

PY - 2015/12/19

Y1 - 2015/12/19

N2 - Background: Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits.Methods: We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123).Findings: 782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3-99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8-99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21-0·80; p<0·0001).Interpretation: Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital. Implementation of this approach could substantially reduce hospital admissions and have major benefits for both patients and health-care providers.Funding: British Heart Foundation and Chief Scientist Office (Scotland).

AB - Background: Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits.Methods: We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay. In derivation and validation cohorts, we evaluated the negative predictive value of a range of troponin concentrations for the primary outcome of index myocardial infarction, or subsequent myocardial infarction or cardiac death at 30 days. This trial is registered with ClinicalTrials.gov (number NCT01852123).Findings: 782 (16%) of 4870 patients in the derivation cohort had index myocardial infarction, with a further 32 (1%) re-presenting with myocardial infarction and 75 (2%) cardiac deaths at 30 days. In patients without myocardial infarction at presentation, troponin concentrations were less than 5 ng/L in 2311 (61%) of 3799 patients, with a negative predictive value of 99·6% (95% CI 99·3-99·8) for the primary outcome. The negative predictive value was consistent across groups stratified by age, sex, risk factors, and previous cardiovascular disease. In two independent validation cohorts, troponin concentrations were less than 5 ng/L in 594 (56%) of 1061 patients, with an overall negative predictive value of 99·4% (98·8-99·9). At 1 year, these patients had a lower risk of myocardial infarction and cardiac death than did those with a troponin concentration of 5 ng/L or more (0·6% vs 3·3%; adjusted hazard ratio 0·41, 95% CI 0·21-0·80; p<0·0001).Interpretation: Low plasma troponin concentrations identify two-thirds of patients at very low risk of cardiac events who could be discharged from hospital. Implementation of this approach could substantially reduce hospital admissions and have major benefits for both patients and health-care providers.Funding: British Heart Foundation and Chief Scientist Office (Scotland).

U2 - 10.1016/S0140-6736(15)00391-8

DO - 10.1016/S0140-6736(15)00391-8

M3 - Article

C2 - 26454362

SN - 0140-6736

VL - 386

SP - 2481

EP - 2488

JO - The Lancet

JF - The Lancet

IS - 10012

ER -

High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study

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Dr. Anoop Shah’s team announce blood test to determine likelihood of heart attack

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