Language
English
Publication Date
2-9-2024
Journal
European Heart Journal. Acute Cardiovascular Care
DOI
10.1093/ehjacc/zuad146
PMID
38001050
PMCID
PMC10853690
PubMedCentral® Posted Date
11-24-2023
PubMedCentral® Full Text Version
Post-print
Abstract
AIMS: Quality-of-care and safety of patients with suspected acute coronary syndrome (ACS) would benefit if management was independent of which high-sensitivity cardiac troponin (hs-cTn) assay was used for risk stratification. We aimed to determine the concordance of hs-cTn assays to risk-stratify patients with suspected ACS according to the European Society of Cardiology (ESC) 2020 Guidelines.
METHODS AND RESULTS: Blood samples were obtained at arrival and at 2 h from patients with suspected ACS using four hs-cTn assays. The patients were classified into rule-out/observe/rule-in strata based on the ESC 2020 Guidelines. Concordance was determined among the assays for rule-out/observe/rule-in strata. The prevalences of significant underlying disease (≥50% stenosis on coronary computed tomography or inducible myocardial ischaemia on stress testing) and adjudicated ACS, plus quality-of-care outcomes, were compared. Among 238 patients (52.7 ± 8.0 years; 40.3% female), the overall concordance across assays to classify patients into rule-out/observe/rule-in strata was 74.0% (176/238). Platforms significantly differed for rule-out (89.9 vs. 76.5 vs. 78.6 vs. 86.6%, P < 0.001) and observe strata (6.7 vs. 20.6 vs. 17.7 vs. 9.2%, P < 0.001), but not for rule-in strata (3.4 vs. 2.9 vs. 3.8 vs. 4.2%, P = 0.62). Among patients in ruled-out strata, 19.1-21.6% had significant underlying disease and 3.3-4.2% had ACS. The predicted disposition of patients and cost-of-care differed across the assays (all P < 0.001). When compared with observed strata, conventional troponin-based management and predicted quality-of-care outcomes significantly improved with hs-cTn-based strategies (direct discharge: 21.0 vs. 80.3-90.8%; cost-of-care: $3889 ± 4833 vs. $2578 ± 2896-2894 ± 4371, all P < 0.001).
CONCLUSION: Among individuals with suspected ACS, patient management may differ depending on which hs-cTn assay is utilized. More data are needed regarding the implications of inter-assay differences.
TRAIL REGISTRATION: NCT01084239.
Keywords
Female, Humans, Male, Middle Aged, Acute Coronary Syndrome, Biomarkers, Cardiology, Troponin, Acute coronary syndrome, High-sensitivity troponin assay, 0/2 h diagnostic algorithm, Non-invasive diagnostic testing, Quality-of-care outcomes
Published Open-Access
yes
Recommended Citation
Karády, Júlia; Mayrhofer, Thomas; Januzzi, James L; et al., "Agreement Among High-Sensitivity Cardiac Troponin Assays and Non-Invasive Testing, Clinical Outcomes, and Quality-of-Care Outcomes Based on the 2020 European Society of Cardiology Guidelines" (2024). Faculty and Staff Publications. 3934.
https://digitalcommons.library.tmc.edu/baylor_docs/3934
Graphical Abstract