BACKGROUND Identifying low-risk acute heart failure patients safe for discharge from the emergency department is a major unmet need. METHODS AND RESULTS A prospective, observational, multicenter pilot study targeting lower risk acute heart failure patients to determine whether hsTnT (high-sensitivity troponin T) identifies emergency department acute heart failure patients at low risk for rehospitalization and mortality. hsTnT was drawn at baseline and 3 hours. Phone follow-up occurred at 30 and 90 days. The primary end point composite of all-cause mortality, rehospitalization, and emergency department visits at 90 days (changed from 30 days because of lack of mortality events), analyzed using logistic regression. Secondary end points: 30- and 90-day all-cause mortality. hsTnT values less than the 99th percentile were defined as low hsTnT. 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 26.4 ng/L (interquartile range, 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 percentile were not associated with a lower risk for the 90-day primary composite end point (odds ratio, 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 rehospitalization, emergency department visits, and mortality at 90 days. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT02592135.

中文翻译：

---

TACIT（高灵敏度肌钙蛋白 T 排除急性心功能不全试验）。

背景技术识别低风险急性心力衰竭患者可以安全地从急诊科出院是一项未满足的主要需求。方法和结果 一项针对风险较低的急性心力衰竭患者的前瞻性、观察性、多中心试点研究，以确定 hsTnT（高敏肌钙蛋白 T）是否可以识别急诊科急性心力衰竭患者的再住院和死亡率低风险。在基线和 3 小时绘制 hsTnT。电话随访发生在第 30 天和第 90 天。90 天时的全因死亡率、再住院和急诊科就诊（由于缺乏死亡事件而从 30 天更改）的主要终点复合材料，使用逻辑回归分析。次要终点：30 天和 90 天全因死亡率。hsTnT 值小于第 99 个百分位被定义为低 hsTnT。在 527 名入组患者中，499 名构成初始分析组。其中，332 人同时绘制了 0 小时和 3 小时 hsTnT，其中 319 人完成了 30 天的随访。平均年龄为 62 岁，男性占 60%，黑人占 57%。中位 hsTnT 为 26.4 ng/L（四分位距，15.1-44.3）。有 99 例 (21%) 30 天复合事件，13 例 (2.7%) 在 30 天死亡， 25 例 (8.2%) 在 90 天死亡。低于第 99 个百分位的连续 hsTnT 值与 90 天主要复合终点的风险降低无关（优势比，0.79；95% CI，0.42-1.50；P=0.4736）。然而，低 hsTnT 组在 30 天时没有发生死亡，在 90 天时有 1 人死亡。结论 hsTnT 未识别出再住院、急诊就诊和 90 天死亡率等主要结局风险较低的患者。临床试验注册网址：https://www.clinicaltrials。政府 唯一标识符：NCT02592135。