BACC: Benefits of a Highly Sensitive Troponin I 1-Hour Algorithm

Patients arriving at the emergency department with chest pain may be triaged "more quickly and more safely" using a new algorithm that reduces mortality and cuts triage times to one hour, according to results of the BACC study presented Aug. 30 at the ESC Congress 2015 in London.

Dirk Westermann, MD, PhD, from the University Heart Centre Hamburg and the German Centre for Cardiovascular Research, and a team of investigators looked at 1,045 patients with a mean age of 65 years with acute chest pain suggestive of acute myocardial infarction (AMI) presenting at their university hospital's emergency room. Patients were assessed using the standard 3-hour assay as well as the new, highly sensitive troponin I assay.

Results showed that "the best troponin I cut-off value to rule out AMI was 6 ng/L." The investigators next confirmed the clinical relevance of the new cut-off using data from the BiomarCaRE study, which showed that "when individuals from the general population had troponin I values higher than 6 ng/L, they were at increased risk of death or cardiovascular disease, whereas patients with levels below this cut-off could be safely discharged home."

Finally, the researchers applied the new cut-offs to the BAAC cohort, and found that "mortality would have been lower if patients had been triaged with the new algorithm" compared to the 3-hour assay.

"Use of this algorithm in patients with suspected AMI allows for highly accurate and rapid rule-out as well as rule-in, enabling safe discharge or rapid treatment initiation," explains Westermann. "This rapid algorithm might be applicable to clinical practice without a loss of diagnostic safety."

Keywords: ESC Congress, Algorithms, Myocardial Infarction, Troponin, Troponin I, Troponin T, Chest Pain, Emergency Service, Hospital, Patient Discharge, Triage

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