{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T04:34:07Z","timestamp":1793853247324,"version":"4.6.1"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>The High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) pathway risk stratifies emergency department patients with possible acute coronary syndrome. This study aims to determine if the High-STEACS hs-cTnT (high-sensitivity cardiac troponin T) pathway can achieve the \u226599% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (CDMI) in a multisite US cohort of patients with and without known coronary artery disease (CAD).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>A secondary analysis of the STOP-CP (High-Sensitivity Cardiac Troponin T [Gen 5 STAT Assay] to Optimize Chest Pain Risk Stratification) cohort, which enrolled adult emergency department patients with possible acute coronary syndrome at 8 US sites (January 25, 2017\u2013September 6, 2018). Participants were classified into outpatient and admission dispositions using the High-STEACS hs-cTnT pathway. Known CAD was defined as prior MI, coronary revascularization, or \u226570% coronary stenosis. Outcomes included 30-day CDMI and efficacy, defined as the proportion identified for outpatient disposition. NPVs and negative likelihood ratios for 30-day CDMI were calculated. NPVs were compared between CAD subgroups using a Fisher exact test.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Among 1351 patients, 53.2% (719\/1351) were male, 31.4% (424\/1351) had known CAD, and the mean age was 57.4\u00b112.8 years. At 30 days, CDMI occurred in 13.8% (187\/1351). High-STEACS classified 63.4% (857\/1351) to outpatient disposition, of which 2.0% (17\/857) had 30-day CDMI, corresponding to an NPV of 98.0% (95% CI, 96.8\u201398.8) and negative likelihood ratio of 0.13 (95% CI, 0.08\u20130.20). In patients with CAD, 46.9% (199\/424) were classified to outpatient disposition, of which 4.0% (8\/199) had 30-day CDMI. Among patients without CAD, 71.0% (658\/927) were classified to outpatient disposition with 1.4% (9\/658) having 30-day CDMI. The NPV for 30-day CDMI was 96.0% (95% CI, 92.2\u201398.2) in patients with CAD versus 98.6% (95% CI, 97.4\u201399.4) among patients without CAD (\n              <jats:italic>P<\/jats:italic>\n              =0.04). The negative likelihood ratio for 30-day CDMI among patients with CAD was 0.16 (95% CI, 0.08\u20130.31) and 0.12 (95% CI, 0.06\u20130.22) among patients without CAD.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>The High-STEACS hs-cTnT pathway had high efficacy but was unable to achieve the \u226599% NPV safety threshold for 30-day CDMI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02984436.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.124.011084","type":"journal-article","created":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T10:00:39Z","timestamp":1736416839000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Performance of the High-STEACS Early Rule Out Pathway Using hs-cTnT at 30 Days in a Multisite US Cohort"],"prefix":"10.1161","volume":"18","clinical-trial-number":[{"clinical-trial-number":"nct02984436","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3466-8813","authenticated-orcid":true,"given":"Nicklaus P.","family":"Ashburn","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6916-4255","authenticated-orcid":true,"given":"Anna C.","family":"Snavely","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC."},{"name":"Department of Biostatistics and Data Science (A.C.S.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5999-4554","authenticated-orcid":true,"given":"Michael W.","family":"Supples","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6556-7540","authenticated-orcid":true,"given":"Marissa J.","family":"Millard","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2577-016X","authenticated-orcid":true,"given":"Brandon R.","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Florida College of Medicine, Gainesville (B.R.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2612-9083","authenticated-orcid":true,"given":"Robert H.","family":"Christenson","sequence":"additional","affiliation":[{"name":"Department of Pathology (R.H.C.), University of Maryland School of Medicine, Baltimore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Madsen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City (T.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2900-2048","authenticated-orcid":true,"given":"Bryn E.","family":"Mumma","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento (B.E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Hashemian","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (N.P.A., A.C.S., M.W.S., M.J.M., T.H., S.A.M.), Wake Forest University School of Medicine, Winston-Salem, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8301-4421","authenticated-orcid":true,"given":"R. 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