European Society of Cardiology 0/1-Hour, High-Sensitivity Troponin T Algorithm Performance for 90-Day Cardiac Events Among Patients With Known Coronary Disease
Recommended Citation
Snavely AC, Ashburn NP, Allen BR, Christenson R, Nowak RM, Wilkerson R, Mumma BE, Madsen T, Stopyra JP, Mahler SA. European Society of Cardiology 0/1-Hour, High-Sensitivity Troponin T Algorithm Performance for 90-Day Cardiac Events Among Patients With Known Coronary Disease. Acad Emerg Med 2023; 30:17-18.
Document Type
Conference Proceeding
Publication Date
4-20-2023
Publication Title
Acad Emerg Med
Abstract
Background and Objectives: The European Society of Cardiology (ESC) 0/1-h high sensitivity troponin T (hs-cTnT) algorithm does not differentiate risk based on known coronary artery disease (CAD: prior myocardial infarction [MI], coronary revascularization, or ≥70% coronary stenosis). We recently evaluated its performance among patients with known CAD at 30-days, but little is known about its longer-term risk prediction. The objective of this study is to determine and compare the performance of the algorithm at 90-days among patients with and without known CAD. Methods: We performed a pre-planned subgroup analysis of the STOP-CP cohort, which prospectively enrolled ED patients ≥21 years old with symptoms suggestive of ACS without ST-elevation on initial ECG across 8 US sites (1/25/2017-9/ 6/2018). Participants with 0-and 1-h hs-cTnT measures (Roche, Basel, Switzerland) were stratified into rule-out, observe, and rule-in groups using the ESC 0/1-h algorithm. Algorithm performance was tested among patients with or without known CAD, as determined by the treating provider. The primary outcome was major adverse cardiovascular events (MACE; a composite of cardiac death, MI, and coronary revascularization) at 90-days. Fisher's exact tests were used to compare 90-day event and rule-out rates between patients with and without known CAD. Negative predictive values (NPVs) for 90-day MACE with exact 95% confidence intervals were calculated and compared using Fisher's exact test. Results: The STOP-CP study accrued 1430 patients, of which 31.4% (449/1430) had known CAD. MACE at 90-days occurred in 15.5% (221/1430). MACE at 90-days was more common among patients with known CAD vs. those without known CAD (25.6% [115/449] vs. 10.8% [106/981]; p < 0.001). Using the ESC 0/1-h algorithm, 39.6% (178/449) of patients with known CAD and 66.1% (648/981) of patients without known CAD were ruled-out (p < 0.001). Among rule-out patients, 90-day MACE occurred in 9.0% (16/178) of patients with known CAD and 1.5% (10/648) without known CAD (p < 0.001). NPV for 90-day MACE was 91.0% (95% CI 85.8-94.8) among patients with known CAD and 98.5% (95% CI 97.2-99.3) in patients without known CAD (p < 0.001). Conclusion: Patients with known CAD who were ruled-out using the ESC 0/1-h hs-cTnT algorithm had a high rate of missed 90-day cardiac events, suggesting that the ESC 0/1-h hs-cTnT algorithm may not be safe for use among patients with known CAD.
Volume
30
First Page
17
Last Page
18
