Potential performance of a 0 h/1 h algorithm and a single cut-off measure of high-sensitivity troponin T in a diverse population: main results of the IN-HOPE study
Authors' conclusion
In this large multicentre study, a 0 h/1 h algorithm had the potential to classify as rule-in or rule-out in almost 80% of the patients. The rule-out protocol had high negative predictive value regardless of clinical risk scores. Categories of levels of hs-cTn T also showed good accuracy in discriminating risk of the patients with a very favourable prognosis for cardiovascular death in the group with value < 5 ng/L.
Study context
- Population
- Patients admitted to the emergency department (ED) with suspected symptoms of acute myocardial infarction (AMI), 16 sites in Brazil583 prospective, 4.914 retrospective
- Participants
- 5.497 patients
- Comparison
- High-sensitivity cardiac troponin T (hs-cTnT) 0 h/1 h algorithm in patients managed by 0 h/3 h protocol
- Outcome
- Accuracy of 0 h/1 h algorithm overall and in groups with a higher probability of AMI
Methodological detailsmulticentre, prospective cohort with retrospective analysis, 16 sites in Brazil, core lab, theoretical performance (patients managed by 0 h/3 h protocol), All patients followed up for 30 days; events adjudicated
- Multicentre
- Prospective cohort with retrospective analysis
- 16 sites in Brazil
- Core lab
- Theoretical performance (patients managed by 0 h/3 h protocol)
- All patients followed up for 30 days; events adjudicated
Performance
As reported in the abstract
| Test or model | Value | NPV for index AMI | HEART score > 3 |
|---|---|---|---|
| Rule-out | 74.4% | 100% (99.1-100) | 45.3% |
| Rule-in | 7.3% |
Value
Rule-out74.4%
Rule-in7.3%
NPV for index AMI
Rule-out100% (99.1-100)
Rule-in— not stated in the abstract
HEART score > 3
Rule-out45.3%
Rule-in— not stated in the abstract
Further findings
| Outcome | Rule-out | Rule-in |
|---|---|---|
| Death or AMI at 30 daysRule-in value: patients adjudicated as AMI | 0 events | 52.4% |
- 30-day AMI or CV death by troponin level (retrospective, n = 4.914) — 1.091 patients <5 ng/L; no CV deaths at 30 days
- 0
- 30-day AMI or CV death by troponin level (retrospective, n = 4.914): < 5 ng/L 0%
- 30-day AMI or CV death by troponin level (retrospective, n = 4.914): 5–14 ng/L 0.6%
- 30-day AMI or CV death by troponin level (retrospective, n = 4.914): 14–42 ng/L 2.2%
- 30-day AMI or CV death by troponin level (retrospective, n = 4.914): 42–90 ng/L 6.3%
- 30-day AMI or CV death by troponin level (retrospective, n = 4.914): ≥ 90 ng/L 7.7%
Death or AMI at 30 days
- No death or AMI in rule-out group of both 0/1 and 0/3 h algorithms
Risk discrimination in observation group (grey zone)
- GRACE discriminated risk better than HEART score
Original publication
Potential performance of a 0 h/1 h algorithm and a single cut-off measure of high-sensitivity troponin T in a diverse population: main results of the IN-HOPE study. Eur Heart J Acute Cardiovasc Care. Published 14 July 2023. doi:10.
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