European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups
Recommended Citation
Millard MJ, Ashburn NP, Snavely AC, Hashemian T, Supples M, Allen B, Christenson R, Madsen T, McCord J, Mumma B, Stopyra J, Wilkerson RG, and Mahler SA. European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups. Heart 2024.
Document Type
Article
Publication Date
5-23-2024
Publication Title
Heart (British Cardiac Society)
Keywords
Humans, Troponin T, Middle Aged, Algorithms, Male, Female, Adult, Age Factors, Aged, Biomarkers, Myocardial Infarction, Predictive Value of Tests, Young Adult, Prospective Studies, Time Factors, Risk Assessment, Societies, Medical, Chest Pain, Emergency Service, Hospital, United States, Cardiology, Risk Factors
Abstract
BACKGROUND: To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups.
METHODS: We conducted a subgroup analysis of adult emergency department patients with chest pain prospectively enrolled from eight US sites (January 2017 to September 2018). Patients were stratified into rule-out, observation and rule-in zones using the hs-cTnT ESC 0/1-h algorithm and classified as older (≥65 years), middle aged (46-64 years) or young (21-45 years). Patients had 0-hour and 1-hour hs-cTnT measures (Roche Diagnostics) and a History, ECG, Age, Risk factor and Troponin (HEART) score. Fisher's exact tests compared rule-out and 30-day cardiac death or MI rates between ages. NPVs with 95% CIs were calculated for the ESC 0/1-h algorithm with and without the HEART score.
RESULTS: Of 1430 participants, 26.9% (385/1430) were older, 57.4% (821/1430) middle aged and 15.7% (224/1430) young. Cardiac death or MI at 30 days occurred in 12.8% (183/1430). ESC 0/1-h algorithm ruled out 35.6% (137/385) of older, 62.1% (510/821) of middle-aged and 79.9% of (179/224) young patients (p<0.001). NPV for 30-day cardiac death or MI was 97.1% (95% CI 92.7% to 99.2%) among older patients, 98.4% (95% CI 96.9% to 99.3%) in middle-aged patients and 99.4% (95% CI 96.9% to 100%) among young patients. Adding a HEART score increased NPV to 100% (95% CI 87.7% to 100%) for older, 99.2% (95% CI 97.2% to 99.9%) for middle-aged and 99.4% (95% CI 96.6% to 100%) for young patients.
CONCLUSIONS: In older and middle-aged adults, the hs-cTnT ESC 0/1-h algorithm was unable to reach a 99% NPV for 30-day cardiac death or MI unless combined with a HEART score.
TRIAL REGISTRATION NUMBER: NCT02984436.
Medical Subject Headings
Humans; Troponin T; Middle Aged; Algorithms; Male; Female; Adult; Age Factors; Aged; Biomarkers; Myocardial Infarction; Predictive Value of Tests; Young Adult; Prospective Studies; Time Factors; Risk Assessment; Societies, Medical; Chest Pain; Emergency Service, Hospital; United States; Cardiology; Risk Factors
PubMed ID
38471727
ePublication
ePub ahead of print
Volume
110
Issue
12
First Page
838
Last Page
845
