Evidence map›Paper›PMID 39781769›Full record

Observational studyCirculation. Cardiovascular quality and outcomes2025

Performance of the High-STEACS Early Rule Out Pathway Using hs-cTnT at 30 Days in a Multisite US Cohort.

Nicklaus P Ashburn, Anna C Snavely, Michael W Supples, Marissa J Millard, Brandon R Allen, Robert H Christenson, Troy Madsen, Bryn E Mumma, Tara Hashemian, R Gentry Wilkerson and 1 more

Registry-linked trialAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Circulation. Cardiovascular quality and outcomes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02984436 (High-Sensitivity Cardiac Troponin T to OPtimize Chest Pain Risk Stratification), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT02984436 completednot on this map

High-Sensitivity Cardiac Troponin T to OPtimize Chest Pain Risk Stratification

TypeobservationalSponsorUniversity of FloridaRan2017 to 2020Enrolled1,572ConditionsAcute Coronary Syndrome, Chest PainArmsBlood Sample, HEART Score
3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Review
  2. Observational
  3. Review
  4. Observational
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Nicklaus P AshburnDepartment of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC.ORCID 0000-0002-3466-8813
Anna C SnavelyDepartment of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC.ORCID 0000-0001-6916-4255
Michael W SupplesDepartment of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC.ORCID 0000-0001-5999-4554
Marissa J MillardDepartment of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC.ORCID 0009-0000-6556-7540
Brandon R AllenDepartment of Emergency Medicine, University of Florida College of Medicine, Gainesville (B.R.A.).ORCID 0000-0003-2577-016X
Robert H ChristensonDepartment of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore.ORCID 0000-0003-2612-9083
Troy MadsenDepartment of Emergency Medicine, University of Utah School of Medicine, Salt Lake City (T.M.).
Bryn E MummaDepartment of Emergency Medicine, University of California Davis School of Medicine, Sacramento (B.E.M.).ORCID 0000-0002-2900-2048
Tara HashemianDepartment of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC.
R Gentry WilkersonDepartment of Emergency Medicine (R.G.W.), University of Maryland School of Medicine, Baltimore.ORCID 0000-0001-8301-4421
Simon A MahlerDepartment of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC.ORCID 0000-0003-2199-4078

Funding

Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Percutaneous Ultrasound Gastrostomy: Clinical Evaluation of a Novel Method for Feeding Tube PlacementR44DK115325 · NIDDK · COAPTECH, LLC · PI CAROLAN, HOWARD · 2019 to 2020
$1.2M
Understanding the factors affecting hospital performance in out-of-hospital cardiac arrest: A mixed-methods studyK08HL130546 · NHLBI · UNIVERSITY OF CALIFORNIA AT DAVIS · PI MUMMA, BRYN ELISSA · 2016 to 2018
$471k
Initiating Preventive Care for Hyperlipidemia in the Emergency Department: The EMERALD TrialK23HL169929 · NHLBI · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI Nicklaus P Ashburn · 2024 to 2026
$468k
AHRQ HHS R01 HS029017AHRQ HHS R21 HS029234NCATS NIH HHS UL1 TR001420NHLBI NIH HHS K08 HL130546NHLBI NIH HHS K23 HL169929NIDDK NIH HHS R44 DK115325
6 · The paper itself

Abstract

backgroundThe High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) pathway risk stratifies emergency department patients with possible acute coronary syndrome. This study aims to determine if the High-STEACS hs-cTnT (high-sensitivity cardiac troponin T) pathway can achieve the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (CDMI) in a multisite US cohort of patients with and without known coronary artery disease (CAD).

methodsA secondary analysis of the STOP-CP (High-Sensitivity Cardiac Troponin T [Gen 5 STAT Assay] to Optimize Chest Pain Risk Stratification) cohort, which enrolled adult emergency department patients with possible acute coronary syndrome at 8 US sites (January 25, 2017-September 6, 2018). Participants were classified into outpatient and admission dispositions using the High-STEACS hs-cTnT pathway. Known CAD was defined as prior MI, coronary revascularization, or ≥70% coronary stenosis. Outcomes included 30-day CDMI and efficacy, defined as the proportion identified for outpatient disposition. NPVs and negative likelihood ratios for 30-day CDMI were calculated. NPVs were compared between CAD subgroups using a Fisher exact test.

resultsAmong 1351 patients, 53.2% (719/1351) were male, 31.4% (424/1351) had known CAD, and the mean age was 57.4±12.8 years. At 30 days, CDMI occurred in 13.8% (187/1351). High-STEACS classified 63.4% (857/1351) to outpatient disposition, of which 2.0% (17/857) had 30-day CDMI, corresponding to an NPV of 98.0% (95% CI, 96.8-98.8) and negative likelihood ratio of 0.13 (95% CI, 0.08-0.20). In patients with CAD, 46.9% (199/424) were classified to outpatient disposition, of which 4.0% (8/199) had 30-day CDMI. Among patients without CAD, 71.0% (658/927) were classified to outpatient disposition with 1.4% (9/658) having 30-day CDMI. The NPV for 30-day CDMI was 96.0% (95% CI, 92.2-98.2) in patients with CAD versus 98.6% (95% CI, 97.4-99.4) among patients without CAD (

conclusionsThe High-STEACS hs-cTnT pathway had high efficacy but was unable to achieve the ≥99% NPV safety threshold for 30-day CDMI. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02984436.

Indexed as

Acute Coronary SyndromeDecision Support TechniquesTroponin TAgedBiomarkersClinical Decision-MakingEmergency Service, HospitalFemaleHumansMaleMiddle AgedMyocardial InfarctionPredictive Value of TestsPrognosisRisk AssessmentRisk FactorsBiomarkersTroponin Tacute coronary syndromecoronary artery diseasemyocardial infarctiontroponinUnited States

Identifiers

PMID39781769
PMCPMC11902900

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.