British High-STEACS Trial Supports Troponin I Test to Diagnose Heart Attack

October 8, 2015—The British Heart Foundation (BHF) announced the publication of a BHF-funded clinical trial conducted by the University of Edinburgh in Scotland, United Kingdom, that has shown that using a high sensitivity blood test could rule out a heart attack in two thirds of people arriving at United Kingdom hospitals’ Accident and Emergency (A&E) departments with chest pain. The study by Anoop S.V. Shah, MD, et al is available online ahead of print in The Lancet.

The study, high-sensitivity troponin in the evaluation of patients with acute coronary syndrome, or High-STEACS, was composed of more than 6,000 patients with chest pain at four hospitals in Scotland and the United States. The investigators evaluated the best way to use a blood test to measure troponin, and found the threshold at which they could rule out a heart attack and safely send people home.

The investigators found that if a patient has a high sensitivity troponin-I concentration of less than 5 nG/L, he or she is at very low risk of having had a heart attack or having one in the next 30 days. This means that someone could more safely and reliably be directly discharged from hospital, with no need to be admitted. 

Earlier this year, the investigators showed that the same test could double diagnosis rates of heart attacks in women. They found that using different criteria for a positive test in men and women improved diagnosis rates so that one in five women were diagnosed compared with the standard test where just one in ten women were diagnosed.

According to the BHF, the results of this study are likely to be used to shape national and international clinical guidelines on the early rule-out of heart attacks. This will impact how the majority of patients presenting signs of chest pain are managed in A&E, influencing future health care service provision and patient care.

The BHF noted that there are approximately 188,000 heart attacks annually in the United Kingdom; however, chest pain is estimated to be responsible for approximately one million visits to A&E departments each year.

BHF’s Associate Medical Director, Prof. Jeremy Pearson, PhD, commented in the announcement, “A faster, more accurate diagnosis of whether chest pain is caused by a heart attack would be better for patients and save the National Health Services money. We want to ensure no heart attack diagnosis is missed but we equally don’t want to see people go through unnecessary tests and spend extended periods in hospital unless it is essential. No one wants to be in hospital unless they have to be.” Prof. Pearson added, “What’s important about this study is that the evidence shows you can quickly and confidently rule out a heart attack without compromising patient safety.”