Coronary disease & ACSSecondary analysis
Impact of switching high-sensitivity cardiac troponin assays on risk stratification in suspected acute coronary syndrome
- secondary analysis of the TWITCH-ED study
Authors' conclusion
Risk stratification thresholds for hs-cTnI and hs-cTnT assays do not provide equivalent performance. The hs-cTnT assay and threshold identified fewer low-risk patients suitable for discharge, with fewer subsequent cardiovascular events at 1 year.
Study context
- Population
- Patients with suspected acute coronary syndrome, enrolled between October 2020 and October 2022; in October 2021 sites changed from an hs-cTnI to an hs-cTnT assaypatients enrolled in TWITCH-ED
- Participants
- 25,849 patients
- Comparison
- Risk stratification using the hs-cTnI assay compared to the hs-cTnT assay, with low risk at presentation defined by established thresholds
Primary result
As reported in the abstract
Further findings
Discharged following a single troponin measurement
Composite of subsequent myocardial infarction, heart failure hospitalization, or cardiovascular death, among those identified as low-risk · 1 year · lower rates among those identified as low-risk with hs-cTnT
All-cause death, among those identified as low-risk · 1 year · lower rates among those identified as low-risk with hs-cTnT
Age of patients identified as low-risk
- Discharged following a single troponin measurement: P < 0.001
- Composite of subsequent myocardial infarction, heart failure hospitalization, or cardiovascular death, among those identified as low-risk: P < 0.001
- All-cause death, among those identified as low-risk: P < 0.001
Age of patients identified as low-risk
- Low-risk with hs-cTnT were younger with fewer comorbidities
Original publication
Summarised from the published abstract; every number is checked against it