European Society of Cardiology 0/1-hour algorithm (high-sensitivity cardiac troponin T) performance across distinct age groups

• Published in: Heart (British Cardiac Society) Vol. 110; no. 12; p. 838
• Main Authors: Millard, Marissa J, Ashburn, Nicklaus P, Snavely, Anna C, Hashemian, Tara, Supples, Michael, Allen, Brandon, Christenson, Robert, Madsen, Troy, McCord, James, Mumma, Bryn, Stopyra, Jason, Wilkerson, Richard Gentry, Mahler, Simon A
• Format: Journal Article
• Language: English
• Published: England 01-06-2024
• Subjects: Adult; Age Factors; Aged; Algorithms; Biomarkers - blood; Cardiology - standards; Chest Pain - blood; Chest Pain - diagnosis; Chest Pain - etiology; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Predictive Value of Tests; Prospective Studies; Risk Assessment - methods; Risk Factors; Societies, Medical; Time Factors; Troponin T - blood; United States - epidemiology; Young Adult; United States; Biomarkers; Myocardial Infarction; Chest Pain; Acute Coronary Syndrome
• ISSN: 1468-201X
• DOI: 10.1136/heartjnl-2023-323621

To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups.
We conducted a subgroup analysis of adult emergency department patients with chest pain prospectively enrolled from eight US sites (January 2017 to September 2018). Patients were stratified into rule-out, observation and rule-in zones using the hs-cTnT ESC 0/1-h algorithm and classified as older (≥65 years), middle aged (46-64 years) or young (21-45 years). Patients had 0-hour and 1-hour hs-cTnT measures (Roche Diagnostics) and a History, ECG, Age, Risk factor and Troponin (HEART) score. Fisher's exact tests compared rule-out and 30-day cardiac death or MI rates between ages. NPVs with 95% CIs were calculated for the ESC 0/1-h algorithm with and without the HEART score.
Of 1430 participants, 26.9% (385/1430) were older, 57.4% (821/1430) middle aged and 15.7% (224/1430) young. Cardiac death or MI at 30 days occurred in 12.8% (183/1430). ESC 0/1-h algorithm ruled out 35.6% (137/385) of older, 62.1% (510/821) of middle-aged and 79.9% of (179/224) young patients (p<0.001). NPV for 30-day cardiac death or MI was 97.1% (95% CI 92.7% to 99.2%) among older patients, 98.4% (95% CI 96.9% to 99.3%) in middle-aged patients and 99.4% (95% CI 96.9% to 100%) among young patients. Adding a HEART score increased NPV to 100% (95% CI 87.7% to 100%) for older, 99.2% (95% CI 97.2% to 99.9%) for middle-aged and 99.4% (95% CI 96.6% to 100%) for young patients.
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.
NCT02984436.