The hs-cTnI assay identified more patients as low-risk (57.3% vs 17.6%) and led to more discharges after a single troponin measurement (47% vs 30%) compared to the hs-cTnT assay (P<0.001).
Observational (n=25,849)
Sí
Does switching from a hs-cTnI to a hs-cTnT assay influence risk stratification and discharge rates in patients with suspected acute coronary syndrome?
Risk stratification thresholds for hs-cTnI and hs-cTnT assays are not clinically equivalent, with hs-cTnT identifying significantly fewer low-risk patients suitable for early discharge, though these patients had fewer subsequent cardiovascular events.
Tasa de eventos absoluta: 47% vs 30%
valor p: p=<0.001
Abstract Background Cardiac troponin is central to risk stratification in patients with suspected acute coronary syndrome. High-sensitivity assays measuring cardiac troponin (hs-cTn) I or T are recommended by international guidelines. However, diagnostic thresholds for these assays are derived from different populations. We aimed to evaluate whether the change in assay influenced risk stratification. Methods This is a secondary analysis of the TWITCH-ED study enrolling 25,849 patients with suspected acute coronary syndrome between October 2020 and October 2022. In October 2021, sites changed from a hs-cTnI to a hs-cTnT assay. Study outcomes included discharge from the Emergency Department following a single cardiac troponin measurement, a composite outcome of subsequent myocardial infarction, heart failure hospitalization, or cardiovascular death at one year, and all-cause death at one year. Patients were stratified as low-risk at presentation using established thresholds. Results Higher proportions of patients were identified as low-risk (57.3% versus 17.6%) and discharged following a single troponin measurement (47% versus 30%) using the hs-cTnI assay, compared to the hs-cTnT assay (P0.001 for both). Those identified as low-risk with the hs-cTnT assay were younger (median 52 IQR 40-62 versus 41 32-51 years) with fewer comorbidities, and had lower rates for the composite outcome (0.8% versus 0.2%) and all-cause death (2.0% versus 0.3%) (P0.001 for both) at one year. Conclusions 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.
Li et al. (Thu,) conducted a observational in suspected acute coronary syndrome (n=25,849). hs-cTnI assay vs. hs-cTnT assay was evaluated on discharge from the Emergency Department following a single cardiac troponin measurement (p=<0.001). The hs-cTnI assay identified more patients as low-risk (57.3% vs 17.6%) and led to more discharges after a single troponin measurement (47% vs 30%) compared to the hs-cTnT assay (P<0.001).