Trial reportClinical biochemistry2017
Use of the HEART Pathway with high sensitivity cardiac troponins: A secondary analysis.
Trial report in Clinical biochemistry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it.
- High-sensitivity troponin assays for early rule-out of acute myocardial infarction in people with acute chest pain: a systematic review and economic evaluation.Health technology assessment (Winchester, England) · 2021Pooled it
- Safety and Effectiveness of the High-Sensitivity Cardiac Troponin HEART Pathway in Patients With Possible Acute Coronary Syndrome.Circulation. Cardiovascular quality and outcomes · 2024Article
- Emergency Department Cardiac Risk Stratification With High-Sensitivity vs Conventional Troponin HEART Pathway.JAMA network open · 2023Article
- Derivation of a HEAR Pathway for Emergency Department Chest Pain Patients to Safely Avoid a Second Troponin Test.Diagnostics (Basel, Switzerland) · 2023Article
- Outcomes in ED patients with non-specific ECG findings and low high-sensitivity troponin.Journal of the American College of Emergency Physicians open · 2022Article
- Impact of a rapid high-sensitivity troponin pathway on patient flow in an urban emergency department.Journal of the American College of Emergency Physicians open · 2022Article
- Scoring systems for the triage and assessment of short-term cardiovascular risk in patients with acute chest pain.Reviews in cardiovascular medicine · 2021Review
- The disutility of stress testing in low-risk HEART Pathway patients.The American journal of emergency medicine · 2021Article
- Sex and race differences in safety and effectiveness of the HEART pathway accelerated diagnostic protocol for acute chest pain.American heart journal · 2021Article
- HEART Pathway Implementation Safely Reduces Hospitalizations at One Year in Patients With Acute Chest Pain.Annals of emergency medicine · 2020Article
- HEART score improves efficiency of coronary computed tomography angiography in patients suspected of acute coronary syndrome in the emergency department.European heart journal. Acute cardiovascular care · 2020Article
- Safely Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge.Circulation · 2018Article
- Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam: International Exchange, Needs Assessment, and Spatial Care Paths.Point of care · 2018Article
- Combined Use of High-Sensitive Cardiac Troponin, Copeptin, and the Modified HEART Score for Rapid Evaluation of Chest Pain Patients.Disease markers · 2018Article
- Prediction of major adverse cardiovascular events with two risk scales for acute chest pain in the emergency department.Archivos peruanos de cardiologia y cirugia cardiovascularArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors.
Funding
Abstract
objectivesThe HEART Pathway combines a decision aid and serial contemporary cardiac troponin I (cTnI) measures to achieve >99% sensitivity for major adverse cardiac events (MACE) at 30days and early discharge rates >20%. However, the impact of integrating high-sensitivity troponin (hs-cTn) measures into the HEART Pathway has yet to be determined. In this analysis we compare test characteristics of the HEART Pathway using hs-cTnI, hs-cTnT, or cTnI. DESIGN &
methodsA secondary analysis of participants enrolled in the HEART Pathway RCT was conducted. Each patient was risk stratified by the cTn-HEART Pathway (Siemens TnI-Ultra at 0- and 3-h) and a hs-cTn-HEART Pathway using hs-cTnI (Abbott) or hs-cTnT (Roche) at 3-h. The early discharge rate, sensitivity, specificity, and negative predictive value (NPV) for MACE (death, myocardial infarction, or coronary revascularization) at 30days were calculated.
resultshs-cTnI measures were available on 133 patients. MACE occurred in 11/133 (8%) of these patients. Test characteristics for the HEART Pathway using serial cTnI vs 3hour hs-cTnI were the same: sensitivity (100%, 95%CI: 72-100%), specificity (49%, 95%CI: 40-58%), NPV (100%, 95%CI: 94-100%), and early discharge rate (45%, 95%CI: 37-54%). The HEART Pathway using hs-cTnT missed one MACE event (myocardial infarction): sensitivity (91%, 95%CI: 59-100%), specificity (48%, 95%CI: 39-57%), NPV (98%, 95%CI: 91-100%), and early discharge rate (45%, 95%CI: 37-54%).
conclusionsThere was no difference in the test characteristics of the HEART Pathway whether using cTnI or hs-cTnI, with both achieving 100% sensitivity and NPV. Use of hs-cTnT with the HEART Pathway was associated with one missed MACE.
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