La Dra. Silvia Valbuena López analiza el estudio presentado en ESC Congress 2019.

1. Silvia Valbuena LópezHiSTORIC Trial
HIGH SENSITIVITY CARDIAC TROPONIN
AT PRESENTATION TO RULE-OUT
MYOCARDIAL INFARCTION (HISTORIC):
A STEPPED-WEDGE CLUSTER-
RANDOMIZED CONTROLLED TRIAL

2. Silvia Valbuena LópezHiSTORIC Trial
BACKGROUND
• New hsTn test offer an oportunity to improve diagnosis in patients with chest pain
• High sensitivity troponins are now measurable in the majority of men and women
• Diagnosis thereshold and algorhythms need to be optimized and prospectively tested
• The main strength of hsTn is to rule MI out, rather tan to rule it in

3. Silvia Valbuena López
METHODS
HiSTORIC Trial

4. Silvia Valbuena López
METHODS
HiSTORIC Trial

5. Silvia Valbuena López
METHODS
HiSTORIC Trial
• Aim  to evaluate the safety and efficacy of implementing the High-STEACS early rule-out pathway
in consecutive patients with suspected ACS
• 1 year follow-up
• Multicenter, prospective, randomized. Pragmatic design
Standard of care  rule-out if hs-TnI <99th centile at presentation (>6h) or serial testing after 6-12h

6. Silvia Valbuena López
METHODS
HiSTORIC Trial
• Coprimary endpoints
- Length of stay (efficacy)
- MI or cardiac death 30 days after discharge (safety)
• Secondary efficacy endpoint  proportion discharged from emergency
department
• Secondary safety endpoint after 1 year  MI, cardiac death, all-cause death,
unplanned revascularization, re-attendance for any reason

7. Silvia Valbuena López
RESULTS
HiSTORIC Trial

8. Silvia Valbuena López
RESULTS
HiSTORIC Trial

9. Silvia Valbuena López
RESULTS
HiSTORIC Trial
No increase in adverse events at 30 days or 1 year

10. Silvia Valbuena López
LIMITATIONS
HiSTORIC Trial
• High rate of reattendance and high rate of all-cause death ???
• Standard of care protocol indicates repeating hsTnI after 6-12h  artificial
prolongation of emergency department stay

11. Silvia Valbuena López
CONCLUSIONS
HiSTORIC Trial
• En una amplia cohorte de pacientes consecutivos el estudio demostró que una vía de
early rule-out, basada en un doble umbral de riesgo, no sólo es más eficaz si no también
segura
• Su implementación redujo el tiempo de estancia en urgencias y aumentó la proporción de
pacientes dados de alta desde urgencias
• Todo ello sin observase un aumento en los eventos adversos ni a los 30 días ni al año