A randomized trial of a 1-hour troponin T protocol in suspected acute coronary syndromes: The Rapid Assessment of Possible Acute Coronary Syndrome in the Emergency Department With High-Sensitivity Troponin T Study (RAPID-TnT)
Circulation — Chew DP, Lambrakis K, Blyth A, et al. | November 12, 2019
Researchers conducted a multicenter study examining whether a 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol is noninferior to a 0/3-hour masked hs-cTnT protocol in patients with suspected acute coronary syndrome presenting to the emergency department (ED). They randomly assigned 3,378 patients to either a 0/1-hour hs-cTnT protocol (reported to the limit of detection [< 5 ng/L]) or masked hs-cTnT reported to ≤ 29 ng/L evaluated at 0/3-hours (standard arm). Patients with the suspected acute coronary syndrome were more rapidly discharged in correlation to implementing a 0/1-hour hs-cTnT protocol embedded in ED care. Functional cardiac testing was less frequently done among those randomly assigned to the 0/1-hour protocol. Noninferiority of the 0/1-hour hs-cTnT protocol to standard care was supported, despite an increase in myocardial injury with the implementation of the 0/1-hour hs-cTnT protocol. They identified a negative predictive value of 99.6% (95% CI, 99.0–99.9%) for 30-day death or myocardial infarction of the 0/1-hour protocol among patients discharged from ED.