Response by Lambrakis and Chew to Letter Regarding Article, "Late Outcomes of the RAPID-TnT Randomized Controlled Trial: 0/1-Hour High-Sensitivity Troponin T Protocol in Suspected ACS"

Research output: Contribution to journalLetterpeer-review

Abstract

We write in response to Drs Chiang et al concerning the 12-month results of the Rapid Assessment of Possible ACS in the Emergency Department With High Sensitivity Troponin T study (RAPID TnT), a randomized trial embedded within clinical practice evaluating a 0/1-hour protocol using unmasked high-sensitivity troponin T (hs-cTnT) reporting (ie, down to 5 ng/L) compared with our usual care of a 0/3-hour protocol using hs-cTnT reporting that was masked in clinical practice for concentrations <=29 ng/L.1 As correctly pointed out, this study was designed to evaluate the impact of the "information differential" available to the clinician during initial assessment, specifically to assess the changes in clinical practice and 12-month outcomes.2 We are keen to highlight that access to unmasked reporting of hs-cTnT concentrations <29ng/L was confined to the initial assessment of those patients randomized to the 0/1-hour strategy. All subsequent presentations to hospital requiring a troponin draw, regardless of initial randomization arm, were conducted with the 0/3-hour standard approach with only masked reports available in clinical practice. It is critical to note that the masking of hs-cTnT concentrations <=29 ng/L was an administratively applied limit, with absolute hs-cTnT concentrations <=29 ng/L captured and retained for all participants in data systems of the pathology provider.
Original languageEnglish
Pages (from-to)e459-e460
Number of pages2
JournalCirculation
Volume144
Issue number23
DOIs
Publication statusPublished - 7 Dec 2021

Keywords

  • acute coronary syndrome
  • diagnostic testing
  • high-sensitivity troponin
  • myocardial infarction
  • randomized trial

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