Combining troponin-based algorithms with the HEART score instead of standard ACS risk criteria reduced the 30-day risk of MI, mortality, or unplanned revascularization from 3.8-4.9% to 2.2-2.7%.
Cohort (n=932)
Does combining troponin-based algorithms with clinical risk scores improve risk stratification compared to standard ESC ACS risk criteria in patients with suspected NSTE-ACS?
Combining troponin-based algorithms with standardized clinical risk scores like the HEART score halves the prevalence of missed events in rule-out patients compared to standard ESC ACS risk criteria.
AIMS: Troponin-based algorithms are made to identify myocardial infarctions (MIs) but adding either standard acute coronary syndrome (ACS) risk criteria or a clinical risk score may identify more patients eligible for early discharge and patients in need of urgent revascularization. METHODS AND RESULTS: Post-hoc analysis of the WESTCOR study including 932 patients (mean 63 years, 61% male) with suspected NSTE-ACS. Serum samples were collected at 0, 3, and 8-12 h and high-sensitivity cTnT (Roche Diagnostics) and cTnI (Abbott Diagnostics) were analysed. The primary endpoint was MI, all-cause mortality, and unplanned revascularizations within 30 days. Secondary endpoint was non-ST-elevation myocardial infarction (NSTEMI) during index hospitalization. Two combinations were compared: troponin-based algorithms (ESC 0/3 h and the High-STEACS algorithm) and either ACS risk criteria recommended in the ESC guidelines, or one of eleven clinical risk scores, HEART, mHEART, CARE, GRACE, T-MACS, sT-MACS, TIMI, EDACS, sEDACS, Goldman, and Geleijnse-Sanchis. The prevalence of primary events was 21%. Patients ruled out for NSTEMI and regarded low risk of ACS according to ESC guidelines had 3.8-4.9% risk of an event, primarily unplanned revascularizations. Using HEART score instead of ACS risk criteria reduced the number of events to 2.2-2.7%, with maintained efficacy. The secondary endpoint was met by 13%. The troponin-based algorithms without evaluation of ACS risk missed three-index NSTEMIs with a negative predictive value (NPV) of 99.5% and 99.6%. CONCLUSION: Combining ESC 0/3 h or the High-STEACS algorithm with standardized clinical risk scores instead of ACS risk criteria halved the prevalence of rule-out patients in need of revascularization, with maintained efficacy.
Steiro et al. (Fri,) conducted a cohort in suspected NSTE-ACS (n=932). Troponin-based algorithms combined with clinical risk scores (e.g., HEART score) vs. Troponin-based algorithms combined with standard ACS risk criteria was evaluated on MI, all-cause mortality, and unplanned revascularizations within 30 days. Combining troponin-based algorithms with the HEART score instead of standard ACS risk criteria reduced the 30-day risk of MI, mortality, or unplanned revascularization from 3.8-4.9% to 2.2-2.7%.
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