European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups
Authors' conclusion
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.
Study context
- Population
- Adult ED patients with chest pain, 8 US sites, January 2017 to September 2018
- Participants
- 1,430 patients
- Comparison
- ESC 0/1-h high-sensitivity cardiac troponin T (hs-cTnT) algorithm across age groups
- Oldern = 385
- Middle agedn = 821
- Youngn = 224
- Primary endpoint
- NPV of ESC 0/1-h algorithm (hs-cTnT) for cardiac death or MI (safety threshold ≥99%)
- Follow-up
- 30 days
Methodological details8 US sites
- 8 US sites
Primary result
As reported in the abstract
NPV for 30-day cardiac death or MI, ESC 0/1-h algorithm
| Group | NPV | Ruled out |
|---|---|---|
| Older | 97.1% (95% CI 92.7% to 99.2%) | 35.6% (137/385) |
| Middle aged | 98.4% (95% CI 96.9% to 99.3%) | 62.1% (510/821) |
| Young | 99.4% (95% CI 96.9% to 100%) | 79.9% of (179/224) |
NPV
Older97.1% (95% CI 92.7% to 99.2%)
Middle aged98.4% (95% CI 96.9% to 99.3%)
Young99.4% (95% CI 96.9% to 100%)
Ruled out
Older35.6% (137/385)
Middle aged62.1% (510/821)
Young79.9% of (179/224)
- Rule-out rate differed between age groups
- P < 0.001
Further findings
| Outcome | Older | Middle aged | Young |
|---|---|---|---|
| NPV for 30-day cardiac death or MI, ESC 0/1-h algorithm plus HEART score | |||
| NPV | 100% (95% CI 87.7% to 100%) | 99.2% (95% CI 97.2% to 99.9%) | 99.4% (95% CI 96.6% to 100%) |
Cardiac death or myocardial infarction (MI) at 30 days (all participants)
- Cardiac death or MI at 30 days
- 12.8% (183/1430)
Original publication
European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups. Heart. Published 12 March 2024. doi:10.
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