Methodology: 3/5
Usefulness: 2/5
Ashburn NP, et al. JAMA Cardiol. 2023 Apr 1;8(4):347-356.
Question and Methods: The authors completed preplanned subgroup analyses to determine if a 0-1 hour ultra-sensitive troponin algorithm could have a NNP of 99% for prediction of death or MI at 30 days among patients with and without known coronary disease.
Findings: The NNP for 30-day cardiac death or MI was 96.6%(95%CI, 92.8-98.8) among patients with known CAD and 98.9%(95%CI, 97.8-99.6) in patients without (P = .04).
Limitations: U.S. study with different practice pattern and different high sensitivity TnT threshold, higher than expected mortality and MI, and results were different than other studies of larger sample sizes.
Interpretation: The study failed to reach its intended target to have a NPP of 99% for death or MI among patient with or without known CAD using a strategy involving the measurement of high-sensitive TnT at 0-1 hour. We should not be adopting this strategy based on these findings.
By: Dr. Lucy Karp
JC Supervisor: Dr. Christian Vaillancourt
