who should be considered for testing beyond hs-ctn/media/non-clinical/files-pdfs-excel-ms-word...
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Who Should be Considered for Testing Beyond hs-cTn ?
James McCord MDHenry Ford Heart & Vascular
InstituteFeb 26 2020
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Disclosures
• Consultant: Roche, Siemens• Research Support: Roche, Siemens,
Abbott, Beckman
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Answer
1. Pts not low risk with very low hs-cTnat time 0, or rule-out by 0/1-hr algorithm
2. Those not low risk by low hs-cTn with a risk score
Bottom Line: Large % can/should go home for out-patient follow-up
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HIGH-US Trial < LOD
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HIGH-US Trial
• 29 US Hospitals• 2,212 patients• 259 (12%) AMIs
JACC 2019
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Time 0 hs-cTnI < LOD (2 ng/L)
JACC 2019
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Ann Emerg Med Feb 2020
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3 Missed AMIs
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30-Day Death/AMI
Rule-Out Group: 30-Day Death/AMI 2 (0.2%)
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COMPASS-MI Project
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COMPASS-MI
Combined 15 International Trialshs-cTnI and hs-cTnT22,651 patients
NEJM 2019
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COMPASS-MI
NEJM 2019
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hs-cTnT and CTA
124 patients 256-slice CTA hs-cTnT measurements Coronary calcification, stenosis, non-
calcified plaque volume, plaque composition ( soft or calcified), vascular remodeling
Heart 2011;97:823-831
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CTA & hs-cTnT
HEART 2011
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European Society of Cardiology 2020
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Intermediate hs-cTn
• Those that do not meet 0/1-hr algorithm as low risk
• But are still < 99th%• Risk scores can be applied here
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• 8,474 pts• cTn < 99th% over 3 hrs• 30-day MACE (death/AMI): 0.4%
Circulation. 2018;138:2456-2468
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Potential Harm
• Medical Radiation Exposure
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ROMICAT-II
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N ENGL J MED 357:22:2007
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Estimate 1.5-2.0% of cancers from CT Scans
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Controversy/Caution
• Symptoms < 3 hrs 0/1-hr algorithm• Many studies only CP pts• Role of ECG in 0/1-hr algorithm• Role of history in 0/1-hr algorithm
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Conclusion
1. Rule-out 0/1-hr algorithm no test2. Intermediate hs-cTn apply risk score
and no test if low-risk3. Not low risk: Echo, CTA, Stress Test ?4. Radiation exposure should be
considered