Eur Heart J Acute Cardiovasc Care. 2023 Nov 24:zuad146. doi: 10.1093/ehjacc/zuad146. Online ahead of print.
ABSTRACT
BACKGROUND: 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 concordance of hs-cTn assays to risk stratify patients with suspected ACS according to the European Society of Cardiology (ESC) 2020 Guidelines.
METHODS: Blood samples were obtained at arrival and 2 hours from patients with suspected ACS using four hs-cTn assays. Patients were classified into rule-out/observe/rule-in strata based on the ESC2020 Guidelines. Concordance was determined between assays for rule-out/observe/rule-in strata. The prevalence of significant underlying disease (≥50%stenosis on coronary CT or inducible myocardial ischemia on stress testing) and adjudicated ACS, plus quality-of-care outcomes were compared.
RESULTS: Among 238 patients (52.7 ± 8.0years; 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 (3.4% vs 2.9% vs 3.8% vs 4.2%, p = 0.62). Among patients ruled-out, 19.1-21.6% had significant underlying disease and 3.3-4.2% had ACS. Predicted disposition of patients and cost-of-care differed across the assays (all p < 0.001). When compared to observed, conventional troponin-based management, predicted quality-of-care outcomes significantly improved with hs-cTn-based strategies (direct discharge: 21.0% vs 80.3-90.8%; cost-of-care: $3,889 ± 4,833 vs $2,578 ± 2,896-2,894 ± 4,371, 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 implications of inter-assay differences.
PMID:38001050 | DOI:10.1093/ehjacc/zuad146