Key result
Four hs-cTn assays show ~74% concordance for risk-stratifying suspected ACS, differing in rule-out and observe strata.
Why the study?
Quality-of-care and safety of patients with suspected ACS would benefit if management was independent of which hs-cTn assay was used for risk stratification, but concordance among assays was unclear.
Does the choice of high-sensitivity cardiac troponin assay affect risk stratification and predicted quality-of-care outcomes in patients with suspected ACS?
Observational (n=238)
Does the choice of high-sensitivity cardiac troponin assay affect risk stratification and predicted quality-of-care outcomes in patients with suspected ACS?
Patient management and disposition for suspected ACS may differ significantly depending on which high-sensitivity cardiac troponin assay is used for risk stratification.
Assay discordance in ESC 2020 strata may alter disposition and costs; leaves open need for harmonized thresholds in prospective studies.
AIMS: 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 the concordance of hs-cTn assays to risk-stratify patients with suspected ACS according to the European Society of Cardiology (ESC) 2020 Guidelines. METHODS AND RESULTS: Blood samples were obtained at arrival and at 2 h from patients with suspected ACS using four hs-cTn assays. The patients were classified into rule-out/observe/rule-in strata based on the ESC 2020 Guidelines. Concordance was determined among the assays for rule-out/observe/rule-in strata. The prevalences of significant underlying disease (≥50% stenosis on coronary computed tomography or inducible myocardial ischaemia on stress testing) and adjudicated ACS, plus quality-of-care outcomes, were compared. Among 238 patients (52.7 ± 8.0 years; 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 strata (3.4 vs. 2.9 vs. 3.8 vs. 4.2%, P = 0.62). Among patients in ruled-out strata, 19.1-21.6% had significant underlying disease and 3.3-4.2% had ACS. The predicted disposition of patients and cost-of-care differed across the assays (all P < 0.001). When compared with observed strata, conventional troponin-based management and predicted quality-of-care outcomes significantly improved with hs-cTn-based strategies (direct discharge: 21.0 vs. 80.3-90.8%; cost-of-care: $3889 ± 4833 vs. $2578 ± 2896-2894 ± 4371, 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 the implications of inter-assay differences. TRAIL REGISTRATION: NCT01084239.
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Karády et al. (2023) conducted an observational in suspected acute coronary syndrome (ACS) (n=238). Four high-sensitivity cardiac troponin (hs-cTn) assays was evaluated on Concordance among the assays for rule-out/observe/rule-in strata. Overall concordance across four high-sensitivity cardiac troponin assays for risk-stratifying patients with suspected ACS was 74.0%, with significant differences in rule-out and observe strata.
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