Utility of the 0-hour/1-hour high-sensitivity cardiac troponin T algorithm in Asian patients with suspected non-ST elevation myocardial infarction

• Published in: International journal of cardiology 2017-12, Vol.249, p.32-35
• Main Authors: Shiozaki, Masayuki, Inoue, Kenji, Suwa, Satoru, Lee, Chien-Chang, Chikata, Yuichi, Ishiura, Junko, Kimura, Yuki, Fukuda, Kentaro, Tamura, Hiroshi, Fujiwara, Yasumasa, Sumiyoshi, Masataka, Daida, Hiroyuki
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Algorithms; Asian Continental Ancestry Group; Cohort Studies; Emergency department; Female; Follow-Up Studies; High sensitivity troponin T; Humans; Internationality; Japan - epidemiology; Male; Middle Aged; Non-ST Elevated Myocardial Infarction - blood; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - epidemiology; Non-ST elevation myocardial infarction; Prospective Studies; Taiwan - epidemiology; Time Factors; Troponin T - blood
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.09.009

A rapid rule-out or rule-in protocol based on the 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T is recommended by the European Society of Cardiology. However, Asian data are not available. This prospective cohort study included 413 patients with suspected non-ST elevation myocardial infarction in 3 hospitals in Japan and Taiwan from November 2014 to April 2017. Patients were divided into 3groups—rule-out, observe, and rule-in—according to the algorithm. Major adverse cardiovascular events were evaluated at the 30-dayfollow-up. The algorithm ruled out acute myocardial infarction (AMI) in 171 patients with a negative predictive value and sensitivity of 100% (95% confidential interval [CI], 96.8%–100%) and 100% (95% CI, 88.0%–100%), respectively, in the rule-out group. None of the patients were diagnosed with AMI. Among the 127 patients classified into the rule-in group, 47 were diagnosed as having AMI. The positive predictive value and specificity were 33.1% (95% CI, 25.1%–41.9%) and 66.3% (95% CI, 60.2%–72.0%), respectively. Elective catheter intervention was required in 13 patients (5 in the rule-out group, 8 in the observe group) by the 30-dayfollow-up. The Framingham Risk Score (FRS) identified moderate risk in 5 patients and high risk in 8, while the Global Registry of Acute Coronary Events (GRACE) 2.0 risk score identified low risk in 6 patients and moderate risk in 7. The ESC0-hour/1-hour algorithm could be sufficient in Asian patients. The combination with FRS may be more precise than that with the GRACE 2.0 risk score.