TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial)

Abstract

Background Identifying low-risk acute heart failure (AHF) patients safe for discharge from the emergency department (ED) is a major unmet need. Methods A prospective, observational, multi-center pilot study targeting lower risk AHF patients to determine whether high sensitivity troponin T (hsTnT) identifies ED AHF patients at low risk for re-hospitalization and mortality. hsTnT was drawn at baseline and 3 hours. Phone follow up occurred at 30 and 90 days. The primary endpoint: composite of all-cause mortality, re-hospitalization, and ED visits at 90 days (changed from 30 days due to lack of mortality events), analyzed using logistic regression. Secondary endpoints: 30 and 90-day all-cause mortality. hsTnT values less than the 99th%ile were defined as ‘low’ hsTnT. Results Out of 527 enrolled patients, 499 comprised the initial analysis set. Of these, 332 had both 0 and 3-hour hsTnT drawn, of whom 319 completed 30 day follow up. The average age was 62, 60% male, and 57% Black. Median hsTnT was 26.4ng/L (IQR 15.1–44.3). There were 99 (21%) 30-day composite events, 13 (2.7%) deaths at 30 days and 25 deaths (8.2%) at 90 days. Serial hsTnT values below the 99th%ile were not associated with a lower risk for the 90-day primary composite endpoint (OR 0.79 (95% CI 0.42–1.50) p=0.4736). However, no deaths occurred in the low hsTnT group at 30 days with 1 death at 90 days. Conclusions hsTnT did not identify patients at low risk for the primary outcome of re-hospitalization, ED visits, and mortality at 90 days.