La Dra. Silvia Valbuena López resume en #SECenESC19 las conclusiones del estudio presentado en ESC Congress 2019.

1. Silvia Valbuena LópezRAPID – TnT
RAPID-TnT – A randmised trial of a 1-hour troponin
T protocol in suspected acute coronary síndromes:
the Rapid Assessment of Possible ACS
In the emergency Department with high sensitivity
Troponin T
https://doi.org/10.1161/CIRCULATIONAHA.119.042891

2. Silvia Valbuena LópezRAPID – TnT
BACKGROUND
• Suspected ACS consumes a great part of emergency departments resources
• High sensitivity tropinins have the potential to improve early diagnosis of MI, mainly due to their
very high NPV in ruling out MI
• However, increased sensitivity could lead to more downstream cardiac testing  uncertain
benefit, even harm
HYPOTHESIS  compared to standard practice, a clinical care based on a 0/1- hour TnT
protocol will provide non-inferior clinical outcomes at 30 days with greater efficiency

3. Silvia Valbuena LópezRAPID – TnT
METHODS
• Prospective, randomized, “in practice” non-inferiority evaluation of a 0/1 hour
hs-TnT protocol (LoD 5 ng/l), compared to a stantard of care 0/3 hour
protocol with masked hs-TnT reporting (only reporting above 29 ng/l)
• Conducted in 4 ED in Australia
• August 2015-April 2019
• Inclusion criteria  suspected ACS with non-diagnostic ECG for myocardial
ischemia
• Primary outcome  30 day mortality and MI

4. Silvia Valbuena LópezRAPID – TnT
STUDY FLOW

5. Silvia Valbuena LópezRAPID – TnT
METHODS

6. Silvia Valbuena LópezRAPID – TnT
METHODS

7. Silvia Valbuena LópezRAPID – TnT
RESULTS. MANAGEMENT RECOMMENDATION

8. Silvia Valbuena LópezRAPID – TnT
RESULTS. PRIMARY ENDPOINT

9. Silvia Valbuena LópezRAPID – TnT
RESULTS
Discharged from the ED Time in the ED
o Standard  5.6 h
o 0/1 – Hour  4,6 h

10. Silvia Valbuena LópezRAPID – TnT
RESULTS. CARDIAC TEST WITHIN 30 DAYS
All patients TnT ≤ 29 ng/l

11. Silvia Valbuena LópezRAPID – TnT
LIMITATIONS
• Clinical relevance of 0/3 hour vs 0/1 hour protocol
• Still 2 TnT determination
• Recommendations according to protocol but final decision may differ
• Increase in coronary angiogram and coronary revascularization

12. Silvia Valbuena LópezRAPID – TnT
CONCLUSIONES
• Los pacientes clasificados como “rule-out MI” pueden ser dados de alta de manera
segura con una tasa de muerte y reIAM a los 30 días muy baja
• Aunque no mejora el diagnóstico, supone una estrategia más eficiente
• Todo ello a expensas de una mayor tasa de coronariografía y revascularización. La
significación de elevaciones de baja intensidad requerirá más investigación para un
manejo adecuado de estos pacientes