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
Authors' conclusion
Among individuals with suspected ACS, patient management may differ depending on which hs-cTn assay is utilized.
Study context
- Population
- Patients with suspected acute coronary syndrome (ACS) (52.7 ± 8.0 years; 40.3% female)
- Participants
- 238 patients
- Comparison
- Four high-sensitivity cardiac troponin (hs-cTn) assays for risk stratification by European Society of Cardiology (ESC) 2020 Guidelines
- Outcome
- Concordance among hs-cTn assays to classify patients into rule-out/observe/rule-in strata (ESC 2020)
- Follow-up
- Arrival and 2 h
Performance
As reported in the abstract
Concordance across assays (rule-out/observe/rule-in)
Overall concordance across assays
74.0%
176/238
Rule-out strata across platforms (P < 0.001)
89.9 vs. 76.5 vs. 78.6 vs. 86.6%
Observe strata across platforms (P < 0.001)
6.7 vs. 20.6 vs. 17.7 vs. 9.2%
Rule-in strata across platforms (P = 0.62)
3.4 vs. 2.9 vs. 3.8 vs. 4.2%
Further findings
Significant underlying disease and ACS among ruled-out patients
- Significant underlying disease (≥50% stenosis on CT or inducible ischaemia)
- 19.1-21.6%
- Adjudicated ACS
- 3.3-4.2%
Predicted disposition and cost-of-care across assays
- Differed across assays
- all P < 0.001
Quality-of-care: conventional troponin-based management vs hs-cTn-based strategies
- Direct discharge (conventional vs hs-cTn)
- 21.0 vs. 80.3-90.8%
- Cost-of-care (conventional vs hs-cTn)
- $3889 ± 4833 vs. $2578 ± 2896-2894 ± 4371
- All P < 0.001
Original publication
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. Eur Heart J Acute Cardiovasc Care. Published 24 November 2023. doi:10.
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