Derivation and Validation of ESC-0/1-h Algorithm for High-Sensitivity Troponin T and I in Cancer Patients

Area of Science:

• Cardiology
• Oncology
• Biomarker Diagnostics

Background:

• Diagnostic performance of high-sensitivity cardiac troponin T/I (hs-cTnT/I) and European Society of Cardiology (ESC) 0/1-h algorithms for non-ST-elevation myocardial infarction (NSTEMI) is reduced in cancer patients.
• Cancer patients present unique challenges for NSTEMI diagnosis due to potential biomarker alterations.

Purpose of the Study:

• To derive and validate novel hs-cTnT/I cutoffs within the ESC 0/1-h algorithm framework, specifically tailored for patients with active or past cancer.
• To enhance the diagnostic accuracy and clinical utility of hs-cTnT/I testing in the cancer population for NSTEMI detection.

Main Methods:

• International multicenter study analyzing patients with suspected NSTEMI.
• Central adjudication of final diagnoses by two independent cardiologists based on the fourth universal definition of myocardial infarction.
• External validation in two independent cohorts to confirm the generalizability of the derived cutoffs.

Main Results:

• Cancer-optimized ESC 0/1-h hs-cTnT cutoffs significantly increased diagnostic efficacy from 58.6% to 68.0% (P < 0.001), maintaining high sensitivity and specificity.
• Cancer-optimized ESC 0/1-h hs-cTnI-Architect cutoffs improved efficacy from 59.3% to 78.9% (P < 0.001), with preserved sensitivity and specificity.
• Findings were robustly validated in internal and external patient cohorts.

Conclusions:

• The developed cancer-optimized ESC 0/1-h hs-cTnT/I algorithm cutoffs enhance diagnostic efficacy for NSTEMI in cancer patients.
• These optimized cutoffs maintain high safety profiles, ensuring reliable rule-out and rule-in of myocardial infarction.